No Good Healthcare Answers

There’s been a lot of chatter lately about the repeal of Obamacare and the complicated reality this oft-repeated campaign promise presents. It appears Republican mouths may have written a check their elected politicians can’t cash. It seems obvious that despite all their talk of “repeal and replace,” Republicans really don’t have any idea how to “replace” Obamacare, perhaps because the ACA was the GOP’s “replacement” for Democrats’ push for universal healthcare in the first place. Once Democrats adopted the Heritage Foundation’s 1989 healthcare plan, Republicans reflexively opposed it and used it as the lynchpin of their “Operation Obstruct Obama” strategy.

Well, chickens have come home to roost and surprise, surprise, some Republicans are now saying the actual “repeal” might not happen until after the 2020 election. Does this make sense to anyone? Eight more years of people getting used to Obamacare, getting more dependent on the things they like about it, while Republicans back down on a promise in the hopes of continuing to use it as an election tool? Or something? What about that old boogeyman, “uncertainty.” Doesn’t promising to repeal something in eight years create uncertainty? Doesn’t it make it harder for people to accept one of the several sucky “replacement” ideas Republicans are currently arguing over?

So I don’t get it. And hey, it may not happen.

One thing that Republicans seem to really like are these Health Savings Accounts, Flexible Spending Accounts, etc. Apparently, they are “the future of healthcare,” and I hear them as parts of not only whatever will replace the Affordable Care Act but also Medicare reform and the like. We’ve had HSAs, HRAs, etc. over the years and I have to say, I don’t like them. There’s a lot of paperwork you need to keep up with, they all charge fees which eat away at your balance if you don’t use them, and I don’t understand the basic principle behind them.

There seems to be this idea that people are getting unnecessary healthcare and that’s why everything is so damn expensive, so an HSA/FSA will encourage people to be more responsible. I’m sure there are some people who run to the doctor for every little thing but from everything I’ve read, the problem is not that people are getting too much healthcare, it’s that they aren’t getting enough. They put things off until a problem reaches a crisis stage and they end up in the ER.

I don’t get this idea of being given a pile of money to spend, as if that’s going to solve everything. It’s great if you just have ordinary healthcare needs, but what if your family gets hit with a couple of catastrophes? What if you run out? Are you supposed to decide whether to give your kid leukemia treatment or dad gets to go to the hospital after his car accident?

We’ve had an old HSA plan that still has about a thousand dollars in it, going back to some ancient iteration of our health insurance plan. We only use it to buy eyeglasses, but every quarter they take out more money for “fees,” eating away at what’s available for us to actually use.

I know as a good liberal I’m supposed to embrace Single Payer. In principle it’s a good idea but I don’t think it will ever happen and I’m starting to think it’s a waste of time to keep pursuing it, seeing as how we’ve been trying — and failing — to get universal healthcare for over 100 years now. We’ve now reached a point where our current private insurance system, flawed though it is, is too interwoven into our economy to dismantle it. I absolutely hate insurance companies, with a passion, they no longer serve the function they were created to do, and yet they have become such a big part of the economy I don’t see them going away, do you?

And don’t even get me started on Bernie Sanders and his plan for Medicare For All. I never understood how that was supposed to work for the majority of us who get insurance through our employers. Insurance is a benefit. It’s in lieu of a higher salary. Do the Bernie people really think that if employers don’t have to provide that benefit we’re all going to magically get comparable raises?

I’ll admit that I’m no expert on this stuff. I really don’t understand what’s happened to our healthcare system. I don’t understand why everything is so damn expensive now. It didn’t used to be this way. What happened? Can someone explain this to me? One thing I know for sure is that back when I was a kid, the family doctor didn’t drive the most expensive car and live in the biggest mansion in town. Nowadays, our local “headline homes” report of multi-million dollar home sales is routinely populated with healthcare executives, doctors and the like. Some people are getting really rich off our healthcare system, while too many other people are going broke because of it. Does this make sense to anyone?


Filed under health insurance, healthcare, Obamacare

19 responses to “No Good Healthcare Answers

  1. Jim in Memphis

    I think a big portion of the expense has been the introduction of government money into the healthcare system. When the government is going to cover some of the costs, the product costs will rise to consume that money as well as the money people are willing to spend themselves. Just look at college tuition over the years since government grants and government funded loans have become available. Tuition rises because it is assumed you will spend the government money available. Now student debt looms as a major financial issue because no one ever thought to ask if spending $120k for a degree that will only pay $35k per year was a legitimate financial decision to make. Similar financial decisions have been made in the medical fields. is it financially wise to spend billions of dollars to research a drug to fix erectile disfunction? Well when people are willing to spend billions of other peoples money buying the drug then yes it is, but if that money was not there then probably not.

    This is not the only problem of course, but it is definitely a factor that needs to be addressed.

    • That strikes me as utter bullshit, to be honest. For one thing, prices are actually lower when Medicare is paying the bill, because Medicare is such a huge revenue source for providers so it has the leverage to bargain for better prices. It’s why Big Pharma successfully lobbied to keep Medicare from bargaining for better drug prices. And it’s why Republicans want to splinter Medicare off into smaller pieces with “block grants,” all to appease their corporate donors.

      Secondly, what you describe hasn’t happened in other places. Other countries have government money in their education systems and their healthcare systems (more than we do in the US, in fact). Only in America are costs rising at such ridiculous rates. Nor have I seen any policy analysts on the right or left blaming “government money” for cost increases, either. They blame administrative costs, need for tort reform, doctors ordering too many tests (I guess that’s the “overtreatment” argument), etc.

      Money is money. I don’t get why “government money” would be any different from an insurance company’s money, or an HSA account’s money, or in the case of college tuition, a CSP’s money. I have really good insurance, it’s basically 100% free. Co-pays etc. are all covered by my husband’s employer. But I’m not running off to the doctor every time I get a bump or a sniffle. I have a life. I get my flu shot and I get my annual exams and that’s it.

  2. R. Neal

    One sad aspect of all this is that the vast majority of people who voted for candidates promising to repeal Obamacare arent even affected by it because they get insurance through their employers.

    They are voting to hurt poor/working class families who don’t get insurance at work, small business owners and their employees, self-employed, early retirees, young people still on their parents’ policies, etc. And that could include people in their extended family or people they know whose situation they aren’t aware of.

    And they probably don’t even realize the benefits they DO get, like yearly out of pocket caps, no lifetime caps, no exclusions, no rescissions, no copays on physicals and other preventive healthcare, etc.

    The “liberal” media has massively failed on this. But look! Another Trump tweet!

    • Right, well every RWer I’ve spoken to about this (and most are woefully uninformed about it) say they know people who “don’t deserve” free healthcare so therefore they don’t want “mah tax dollahs” paying for JimBob’s bad lifestyle choices. So yeah, it’s punishing the poor, the people they don’t see as deserving of any help.

  3. Joseph Stans

    I believe we should dismantle the ACA and gradually replace it with Universal Health Care Ala the rest of the civilized world and some places that are not even that civilsized. But, since the Yam was elected and I moved to Canada, I really don’t give a crap.

    You guys are perfectly free to shout and roll around in the mud wrestling.

  4. Here’s an idea that might mollify republican voters. One of the most hated aspects of the PPACA was the unprecedented requirement to actually buy or otherwise merit health insurance to be considered a legitimate or productive member of society…After all, no one else is put in jeopardy by your own poor health. It is something that you handle on your own. Shouldn’t people simply be left to deal with the choices that they have made?

    So, in a nod to freedom, we no longer require every citizen to have insurance. Nor do we deny them the opportunity to sign up in the event of catastrophic or sudden need.

    They simply must submit to three weeks of public shaming. The first week, five of their peers shall berate them mercilessly for ninety minutes a day. The next week, the general public shall be invited to humiliate them and call them every manner of name for no more than one hour, three times a week.
    The third week they shall have their reckoning as they are relentlessly blamed for the rising cost of health care and their own lack of earning power by small panels of four to five individuals for up to ninety minutes a day.

  5. themadkansan

    …I had to break down and sign up through this year. The family is going to make the premium payments (full price since I’m too poor to get subsidies…), because I =need= insurance now, to address issues that cannot be put off any longer lest they totally cripple me. So OF COURSE we have to elect a Vulgar Talking Yam who will give the right-wing nutters in Congress anything they want…


  6. Thomas Wallace

    I enjoyed this post.. I have said and written a lot of the things you wrote and I understand your frustrations.
    I am one of those people who doesn’t go to the doctor except when I have to have a physical to drive truck legally. The doctor, in these cases, is usually upset when I tell him that I don’t have a doctor. I don’t get the flu shot either and will not. I am not a denier, I just don’t believe in them. 🙂
    Again, I enjoy your writing and I hope you will forgive me for anything I have said about Bernie.
    One further thought: My dad, who always voted republican because of gun control, would say many times when I was a kid; “Universal health care is the only thing that will solve the problem.” I don’t know if he was right because much of what he believed and said was wrong, but for a republican voter to say this…
    I think this nation will be dead before it could have a solution to the healthcare cost problem. That solution is not just single payer or universal healthcare. It is a combination of approaches to health and not just sick care. Obama mentioned this in his interview with Bill Maher. I recommend a review of that interview. We are a sick nation because we don’t take care of our bodies from the time of conception (this isn’t just the woman taking care of her body, but the man or potential father should be taking care of his DNA, too. When will the insurance companies try to regulate how we eat and exercise? Or, if it were the government, would we be required to eat a proper diet for our particular body and get the right amount of sleep and exercise for our particular body which would require tests and evaluations? But, that is the only way to have “healthcare” instead of sickcare.

    • I’ve heard it said that the insurance industry and medical profession make their money off of sick people, not well people, thus well-care and preventative care are not prioritized. This may be true but good grief, our culture certainly does. Every new book, every magazine, every morning news show, every you name it is filled with tips and advice (much of it crackpot science) on how to stay well. Dr. Oz has made an entire career out of hawking his snake oil. I want to cringe whenever I hear a “news report” that “scientists in Sweden have discovered raspberry leaf prevents cancer” or some such, and it’s some obscure study on 5 rats or something.

      Anyway, at some point the costs of our fucked up system will necessitate an intervention. That’s how we got Obamacare, imperfect though it is. It was always a first step. Will be interesting to see what happens next.

  7. democommie

    The inconvenient fact of healthcare cost is that it’s already subsidized to an enormous extent, just not on the consumer side.

    Hospitals (especially teaching hospitals), drug companies, insurance companies and the rest of the vast apparatus of the AII (American Illness Industry) get direct cash subsidies and tax breaks amounting to many billiona of dollars–every year.

    If we were being honest about where the healthcare dollar is being spent (mostly on the olds,. like me) and said, “Well, after you’re three score and ten, Pops, you’re on your own”, for shit like heart valves and the like, you’d hear some SERIOUS bleating from the Trumpsheeple.

    • Thomas Wallace

      I guess it is the quest for immortality that keeps people pouring money into bodies that are going to die, no matter what is done or how much money is spent. We don’t want to let go of loved ones so we experiment and inflict enormous pain on them… Not that I advocate suicide or assisted suicide but as you suggest; when we reach a certain age should we consider the cost of one more procedure? If we didn’t have insurance, it would not happen anyway. My grandfather used up his savings on cancer treatments that were not going to save him, but he was convinced that it would help future generations. I wonder

    • evodevo

      You’ve hit on one of the reasons for the skyrocketing costs … there are NOW ways to save someone in the throes of, say, coronary artery disease. I am somewhat familiar with the history of hospitalization costs, since my father ran a local hospital in a small Ky town in the late fifties and sixties. If you were 55 and male, you were put on digitalis (and a couple other things) by your family dr. and if you threw a clot and had a heart attack (quite frequently the outcome of eating lard-fried everything), you just died. There were no bypasses, transplants, stents, etc. If you got cancer, it was usually stage 3 or 4, since there were no mammograms, colonoscopies, PSA tests, etc. and you went through rather primitive radiation/chemotherapy treatments and then died. Diabetes 2 was usually undiagnosed until your feet started numbing up from neuropathy or you started going blind….treatment for that was usually too little too late. All the life-saving therapies we have nowadays are expensive, and people have a tendency to demand them, and here we are. There is also the fact that BigPharma has decided over the last 20 years to jack up prices to insane levels, because they can. That doesn’t help either.

      • Thanks, that makes sense. That the GOP actually passed legislation forbidding Medicare from negotiating better prices and thus keeping prescriptions outrageously expensive should have caused rioting in the streets. But Fox News doesn’t report on anything that makes Republicans look bad.

  8. democommie

    Brw, “Cheetoh Mussolini” isn’t half bad, but I like Trumpligula, even better.

  9. A comprehensive healthcare delivery system could be established here, but probably never will due to the very adroit manner in which those on the Right have framed their opposition as another our tax money, helping “them” i.e. undeserving people, people of color and those foolish enough to be stricken with illness while poor or born with a pre-existing condition. The National Health System in the UK, a single payer system, is funded by a 5% mandatory subscription contribution on incomes over $900 per month, but less than $9,000 a month, and a 2% levy on all incomes above $9,000 per month with no cap, I believe, but it is also subsidized to the tune of about 80% from general tax revenues, including revenue generated by the (currently) 20% Value Added Tax, on most goods and services, a sort of sales tax, certainly a consumption tax which is rolled into the retail price, so you never think about it when paying at the check-out. I question whether Americans would accept such an increase in taxation to have the proceeds redistributed in equal healthcare access to all, no matter how advantageous this would be for the health security of the nation. I think we are simply too selfish, too unconcerned about public health and too susceptible to the propaganda and lies disseminated by the AMA and Big Pharma to think clearly about where our common interest resides. Honestly, it will take a major pandemic of the type Bill Gates recently warned of, so severe and so extensive that even the coddled rich in their guard-gated, private worlds will be stricken, that it will dawn on Congress to do something, if only to stop all these dying, pustulating, sick poor people infecting them and their rentier/corporate class owners…and Lord knows where they will procure all the low-wage help they need. The surviving peasants will be so diminished in numbers that they will successfully demand higher wages, as in the aftermath of the Great Plagues in Medieval Europe!!??

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