Tag Archives: Affordable Care Act

Republican Healthcare – or Lack Thereof

About the only way I know to lower the cost of health insurance for those willing and able to buy it is to let people die on the curb in front of the hospital. Yep, give up your humanity and you too can save on health insurance.

If you opt for humanity and take that person into the hospital, it will cost you, and likely cost you a lot. That person without health insurance will incur costs which the hospital must absorb. The only way a hospital to stay in business if they accept indigent care is to charge paying customers, usually insurers, more to offset the unreimbursed care.

If we are to be humane and provide care for the free riders, is there a better way? If we wait for high blood pressure to cause a heart attack, treatment of that one condition can cost hundreds of thousands to millions of dollars. Alternately, drugs to manage the high blood pressure can cost pennies a day – Penny wise, pound foolish.

The reason the republicans struggle to produce a health plan to replace the ACA, even though they have had several years, is there is no plan that actually works if it doesn’t include everybody. There are two ways to do that – make sure everybody has access to affordable care through private insurers or go to a less costly single payer universal healthcare system like just about every other country in the world.

Government managed systems work well. We currently spend much more per capita for healthcare and with poorer outcomes. There are over 40 countries with lower infant mortality rates, greater life expectancies and lower costs.

The new president said while campaigning that his replacement healthcare plan would cover everybody and cost less. As to the costs we won’t know until after the Congressional Budget Office (CBO) scores the new bill. I can predict immediately however that it won’t cover everybody because the first line of conservative talking points is repealing the mandate to purchase insurance, guaranteeing free riders. Another promise is to lower ACA spending, which means that subsidies for the poor will be lowered or eliminated, further reducing the pool of insured.

For those middle income folks there may be cheaper insurance policies available, but only because substandard policies will again become available. Lower costs mean lower coverage. The ACA policies required a minimum standard of coverage which included preventive care. Cheap policies will be available which only cover catastrophic costs. Ironically, avoiding the costs of preventive care leads to greater catastrophic costs.

The real winners with the proposed healthcare law are the rich, no surprise there. Taxes will go down while at the same time subsides not previously available to the rich will go up.

Conservatives continue to try to view healthcare as subject to the same market forces as buying unessential commodities, but it just doesn’t work that way. We are alone in the world with our failure to make that recognition.

Trump(doesn’t)care

Generally the citizens of red states take in more from the feds than they pay out in taxes. Conversely blue states pay out more than they take in. There are exceptions, red Kansas pays out more than it takes in and blue New Mexico takes in more than it pays out.

Both Trump and the Republicans in congress have repeatedly stressed their plan to repeal the Patient Protection and Affordable Care Act (Obamacare.) Will it be replaced? If So what will replace it? House majority leader Kevin McCarthy said “”Nothing’s been decided yet but I would move through and repeal and then go to work on replacing.” There are several competing ideas floating around, all of which will mean less support for healthcare.

The medicaid expansion is certain to go, eliminating healthcare support for about 14 million people nation wide. Most republican plans drive people with pre-existing conditions into very expensive high risk pools, essentially eliminating insurance for those with lower incomes. Most republican plans will return to annual and/or lifetime limits – exceed your limit and you no longer have insurance at any cost.

People will continue to get sick, insurance or not. In fact without the preventive care measures built into Obamacare, they likely will get more sick. Without reasonable healthcare protections, they won’t be able to afford to go to a clinic for treatment of a cold. They will wait until on death’s bed with pneumonia before they go to the hospital for treatment but can’t pay with dollars they don’t have.

So our population will suffer more serious health care emergencies, increased medical bankruptcies will lower payments to hospitals and staff, and smaller rural hospitals which operate on narrower margins will close their doors, further decreasing access to health care for much of the state’s working poor.

And it won’t stop with just healthcare. Expect cuts to any number of federal programs including food stamps, housing subsidies, subsidies for transportation, etc.

Here in Arkansas we are one of the net takers receiving more in federal dollars than we pay in taxes. Over 684,000 votes were cast for Trump. Around a half a million voters and their children will lose some or all of their healthcare support. Another half a million more could lose some or all of their nutritional support (foodstamps, WIC) including children. What do you think a Venn diagram of Trump voters and beneficiaries of federal largess would look like? Considerable overlap?

The real irony in all this is that the republicans’ lust for smaller government will negatively impact their voter base in the red states. The more prosperous blue states will have their treasuries buoyed by the reduction in federal tax payments. They can use that money to provide for the health and welfare of their citizens. The less prosperous red states will be allowed to continue on a downward spiral with lower wages, poorer health and an every person for themselves paradise. Be careful what you wish (vote) for.

Interstate Health Insurance?

If the Republicans win the general election in the fall and Obamacare is repealed, what happens? Several common threads run through the various strategies from Republican front runners.

The most odious feature of the the Patient Protection and Affordable Care Act (PPACA) among conservatives seems to be the mandate, so it will go. If you don’t want to buy insurance, you don’t have to. If for example you get pneumonia from an untreated infection, you can go to the hospital and get free care. For the hospital to remain in business however, they have to cover the cost of the “free” care with higher costs to the paying customers – the insurance companies. And remember that emergency care is the most expensive way to deliver care, bar none. The cost to those who buy insurance will go up to subsidize the uninsured. This doesn’t do anything to lower costs, it’s what we had before and it is a silly way to keep everybody healthy.

So everyone, republicans included, realizes that steps need to be taken to bring down the cost of healthcare and one thing you hear constantly is that allowing the purchase of insurance across states lines will increase competition and thereby lower costs. Will it work? It works with widgets. If someone in another state sells widgets at a lower price than that can be bought here, then go there to buy where the price is lower.

The story with health insurance is quite a bit more complex. The PPACA includes provisions that already allow the purchase of health insurance across state lines. The difference between the PPACA compact provisions and earlier interstate sales provisions are that the PPACA requires all states to comply with a minimum level of insurance coverage. But interstate sales is not happening, so why?

Insurance companies make money by negotiating prices for “healthcare commodities” – doctors fees, hospital costs, laboratory costs, drug costs etc. All these costs are negotiated to control costs to the policy holders. The nature of the policies sold in a state are regulated in the state.

Georgia, Maine, and Wyoming are states that have taken the step to promote interstate sales. The problem is not that regulations prevent it, but rather no insurers are interested. In none of the aforementioned states, has an out of state insurer expressed interest in selling in those states. This is partly due to the fact that out of state insurers will still have to abide by the rules in the states where they sell.

Eventually it may happen. There is a case to be made that costs are lower the bigger the pool of insured, and crossing state lines could expand the pool for a given insurer. In some markets such as large metropolitan areas that cross state lines, this could happen sooner rather than later, but the development will take time. How how much will this lower the cost to a consumer?

Experts cite the fact that insurance costs depends on how healthy a given group of policy holders are. Arkansans currently have the highest obesity rate in the country, Colorado the lowest. If an insurer from Colorado wanted to sell in Arkansas, the policy costs would be base on the obese Arkansas pool, not the fit Colorado pool. Consequently what cost savings may occur would be small.

In a final irony, a catch-22 of sorts, interstate sales of insurance means federal regulation, anathema to generally states rights conservatives.

Affordable Care Act

Disincentivizing Work

The Republicans have a bright and shiny new word they’re using to bash the Democratic Party in general and Obamacare in particular — Disincentivize. As in Obamacare disincentivizes Americans to work.

This characteristically disingenuous attack on The Affordable Care Act (ACA) comes from a purposeful misinterpretation of a recent Congressional Budget Office report titled “The budget and Economic Outlook: 2014 and 2024.” About 30 pages out of 175 addressed the ACA.

The point the Republicans tried to exploit was a couple of lines that said “The ACA will reduce the total number of hours worked, on net, by about 1.5 percent to 2.0 percent during the period from 2017 to 2024, almost entirely because workers will choose to supply less labor — given the new taxes and other incentives they will face and the financial benefits some will receive.”

See, ensuring access to healthcare takes away jobs! No, not really. What the report said is some people who previously had to keep a full-time job just to be insured may not need to. The ACA ensures that affordable insurance is available to individuals regardless of pre-existing conditions or income.

People who can now get insurance on the open market can decide to work less, or retire a little earlier than they would have. If a person retires early, this opens up a job for another worker — a far cry from taking away jobs.

Once it was clear that jobs weren’t being taken away, the Republicans switched to the disincentivise mantra. This is their argument: If a person doesn’t have to work to maintain access to expensive health insurance, then they won’t work. Access to affordable healthcare makes us lazy. Really, that’s what they think.

Republicans have traditionally resisted just about everything which contributes to the quality of life. People are lazy because they would like to be able to spend more time with their family? People are lazy because after working long and hard, and saving their money, would then like to retire a little earlier? People are lazy because they would rather not work two jobs if they didn’t have to? Really?

Americans already work the longest hours among workers in the industrialized world. That means we have less time to be with our families, less time to enjoy time with friends, less time to volunteer for our church or club. What is wrong with this picture?

You know what else disincentivizes people to work? Those things that contribute to the enjoyment of the American dream — the 40-hour work week, overtime pay, Social Security, Medicare, Medicaid, and now the Patient Protection and Affordable Care Act.

Should we get rid of the mortgage deduction for home ownership and the dependent allowances on our income tax? Saving money disincentivizes work? Meanwhile, the Republican controlled House of Representatives will be taking the next two weeks off, on our dime. What’s that about disincentives to work?

ObamaCare

Republican Irresponsibility

The real irony of Republican pique over Obamacare is the fact that it is a Republican idea. The final form of the Patient Protection and Affordable Care Act (PPACA) relies on Americans to take personal responsibility for their healthcare. It is not a complex formula; buy insurance that covers for the eventualities we all face, be it accident or illness. For those who can’t afford it, costs are subsidized by tax payers according to a sliding income scale.

What conservatives now seem to be saying is that personal responsibility is an onerous burden and purchasing insurance which covers the full cost of accidental injury or illness shouldn’t be necessary. Conservatives think that cheap policies with limited coverage, high deductibles, large co-pays or caps on payments are just fine.

But what happens when these inferior policies fail to pay the cost of care? Then who pays? Currently very close to half of all bankruptcies involve medical costs. That’s no way to run a healthcare system. And conservatives know it, at least knew it. Even before President Clinton proposed a single payer “medicare for all” type of healthcare system, the Heritage Foundation proposed an individual mandate for the purchase of insurance, just like Obamacare. It included a minimum standard of coverage, just like Obamacare. It even included a mandate to insure those with pre-existing conditions, just like Obamacare.

Whether we’re talking about Romneycare, Obamacare, or the Heritage Foundation policy, they all keep the private for profit insurance market alive. They all reduce costs because greater coverage increases access to preventive care, the cheapest and most effective expenditure. And they all mandate that personal responsibility is the centerpiece for healthcare in the United States.

We collectively provide for our national defense, isn’t our national health just as important? We have a single payer military, where everybody, through income taxes, pays their share. We don’t get to choose just how much defense we want, we are mandated to buy the same military. And single payer courts, and single payer disaster relief, and on and on and on. It’s the personal responsibility to our general welfare. E Pluribus Unum – from many, one.

The focus of the Republican party has been to avoid any collective action on healthcare. Democrats since at least the Truman administration have tried to make healthcare more inclusive. To the point of adopting a Republican approach. They’re still not happy.

ObamaCare

ObamaCares

Quality health care in the United States has until recently been a luxury; that is, something only for those that can afford it. This should change over the next few years as the Patient Protection and Affordable Care Act – more colloquially known as Obamacare – rolls out.

healthcare costs

healthcare costs

Currently our system of “every man/woman/family for themselves” has resulted in total health care costs which are on the order of twice the rest of the industrialized world as measured as a fraction of the gross domestic product.

Sadly, because of our past approach, we’ve end up with poorer health care outcomes such as higher infant mortality rates and shorter life expectancies. There are several reasons why we pay more but get less compared to the rest of the world. First and foremost is the lack of preventive care for the poor or those that think it is unnecessary.

infant mortality

infant mortality

When it comes to health care, the old saw “an ounce of prevention is worth a pound of cure” rules. An example or two should suffice: The absolutely most effective health care dollar spent is the dollar spent on vaccinations. Horrible diseases such as small pox and polio have been eradicated. Other diseases that caused high infant mortality rates such as diphtheria and pertussis in the past have been drastically reduced.

Yet much preventive care is unachieved. Consider heart attacks and stokes as a cost factor. Either of these conditions can cost hundreds of thousands of dollars to treat after the fact, but literally pennies a day to prevent with blood pressure medication.

Over a million families file for bankruptcy every year. Medical bills are the principle cause or contribute to these filings over sixty per cent of the time. Obamacare will reduce bankruptcies by abolishing lifetime benefit limits and price discrimination for pre-existing conditions, thus lowering out of pocket costs for families.

What is cheaper to you personally? Assisting the poor (and mandating those who can but refuse to) obtain health care? Or picking up their tab through higher premiums for your health care? The rest of the world has the answer and it is the former. That is why Obamacare will lower costs overall by adopting policies which favor preventive care and full participation in our common care.

Considerably more savings in health care can be had if we control costs via even more collective action. A Titanium alloy hip joint costs about 350 bucks to produce yet insurers are charged close to ten thousand dollars, a markup of three thousand per cent! Why? Because they can, and we pay unnecessarily. In Belgium, on the other hand, the national health system takes a bid for the same joint. The resultant cost is less than a thousand dollars, a tenth of the cost we pay for the exact same item.

There are many things that benefit us collectively such as education, police and fire protection, national defense, infrastructure for commerce, scientific research, and the list goes on and on. It is time we recognize that our health care should fall into the same category. The Patient Protection and Affordable Care Act is a step in the right direction but there is still more that can be done to lower costs further and improve care.