Repeal Proceeds, Replace Not So Much

Just to build on this post, I woke up to a flurry of headlines about the repeal of Obamacare (here, here, and here), but very little has been said about what will replace it.

Meanwhile, the New York Times reports that Trump supporters are not exactly fired up about repealing the healthcare law:

Those voters have been disappointed by Obamacare, but they could be even more disappointed by Republican alternatives to replace it. They have no strong ideological views about repealing and replacing the Affordable Care Act, or future directions for health policy. What they want are pragmatic solutions to their insurance problems. The very last thing they want is higher out-of-pocket costs.

Yes, well, duh. I’ve been saying this for years, haven’t I? And thank you, Kaiser Foundation, for actually asking people what they want. Because this conversation seems to have ignored the healthcare consumer, hasn’t it? We hear precious little from actual people about healthcare, but we sure hear a lot about what the insurance companies want, what the AMA wants, and what BigPharma wants. I’m tired of hearing what they want. If repeal is inevitable, shouldn’t we find out what consumers want (and don’t want) to replace it?

Things I don’t want:

• I don’t want to “shop” for healthcare or my health insurance. I hate shopping anyway, but who wants to “shop” for something like health insurance? People, I do not have the time for that! This infatuation with “shopping” and “marketplaces” in America is something I do not understand. People want to shop for fun stuff. They do not want to shop for un-fun stuff.

I don’t want to compare healthcare plans and read the fine print and find out who’s selling me a shit sandwich and who’s selling me a Tiffany watch. I don’t want to think I have the Tiffany plan only to find out, too late, that I bought a shit sandwich and oh well, sucks to be me. This is not how healthcare is supposed to work.

• I don’t want a “health savings account,” a tax deduction for making a contribution to said “savings account,” or a voucher, coupon or other gimmick. This is something else I don’t get. Conservatives are always saying you can’t throw money at a problem but isn’t that what these special accounts and vouchers do, at their heart? So I have a pile of money I can use as I see fit, so what. That’s great when I’m healthy, but what if something awful happens and my costs exceed what’s in the account? What if my kid gets leukemia and my husband gets in a car accident? Who has the time to keep up with all of the red tape and paperwork associated with these accounts? Everyone is already complaining about how complicated taxes are, but an HSA just adds to that. You have to keep every single receipt and keep up with your statements and there are fees associated with these accounts and it’s just a ginormous headache.

• I don’t care if I can buy health insurance across state lines. What is the point of this? Republicans always mention this as a key part of their plans, but how is this supposed to make my life better? I know the idea is that it will create “competition” and thus lower costs, but does it really? Where is the evidence of this? There is none. In fact, Medicare Advantage plans are uniform across the country, but there are still very limited choices, which means removing the hodge-podge of state regulations really doesn’t increase “choice.”

Furthermore, the insurance companies themselves have not embraced this idea.

Healthcare is not laundry detergent. There are huge regional differences in people’s health. It’s well known that Southern states have some of the worst health statistics in the country: higher rates of obesity, diabetes, heart disease, etc. This is where insurance is more expensive. In states where people tend to be healthier — California, Colorado, Minnesota — insurance tends to be cheaper. So wouldn’t allowing someone in Alabama to buy insurance from Colorado actually increase costs because you’re adding all those unhealthy Southerners into the pool?

• I don’t want medical malpractice “reform.” This is another favorite Republican talking point: medical malpractice insurance is killing healthcare, frivolous lawsuits are killing healthcare, etc. It’s not true. And if some Doctor Fuckup injures a patient, that patient should have the right to sue.

Speaking of frivolous lawsuits, you know where they don’t have to worry about that stuff? Countries with a functioning healthcare system. Let my tell you about my American friend who opened a hotel in Norway. When he asked about liability insurance for the property, his Norwegian business partners looked at him like he was crazy. They don’t have that here, they said. What would be the point? My friend said, you know, if someone slips and falls in the lobby, they could sue to get their medical costs taken care of. They laughed at him. Why would someone do that? The social safety net already takes care of people’s medical costs in Norway! And a big ol’ lightbulb went off.

• I don’t want to have to fly to Poland to buy insulin. Seriously, you know your healthcare system is broken when this happens:

One man in Pennsylvania with Type 1 diabetes reported making frequent trips to Eastern Europe to purchase insulin at one-tenth the cost he paid here.

This is not unusual. I have a friend who lives part-time in India, part-time in the U.S. She broke her foot a few years ago and had it fixed in India for $15. She said this was a good deal, even when one includes the airfare, because back then she didn’t have insurance. This strikes me as ridiculous, but this is what right-wingers gleefully call “medical tourism,” as if flying to Thailand for your heart surgery makes sense. Yeah, if I’m going to Thailand it’s as a tourist, not a patient.

Okay, in summary: I don’t want red tape and paperwork, high prices, a lot of extra work and time spent figuring coverage out or getting the healthcare I need, or unreasonable restrictions on who I can see or what is covered.

What do I want? What does anyone want? This:


It’s really that simple. Just those two things. Any plan, be it from the Democrats or the Republicans, needs to address those two simple things. If it doesn’t, then I’m not interested.

I say “simple things” but I realize it’s far more complicated than that. But seriously, it shouldn’t be that hard to figure this out.


Filed under health insurance, healthcare, Obamacare

16 responses to “Repeal Proceeds, Replace Not So Much

  1. Joseph Stans

    I fainted in a coffee shop. The next thing I knew I was on the floor with the paramedics hovering over me. They asked if I wanted to go to the hospital???

    How the hell do I know? If I were a doctor Ip probably would not have fainted in the first place. I went to the emergency room and was diagnosed with atrial fibrilation. And a cardiac ablation procedure in two days.
    At what point in the process should I have relied on the marketplace? How could I make a decision about how to handle an unknown health issue while laying on the floor in a confused state.

    The theoretical marketplace is exactly that, theoretical – not real. There are some things that simply will not fit in the model of a marketplace. Heath care is one of them. Why is it necessary to explain that to conservatives?

    • Because their entire world view has the word “market” in it. FREE MARKET duh.

      Hope you are OK. I’m sure the paramedics would have been glad to wait 3 hours while you quickly researched all your healthcare options, prices, etc. and “shopped” for the best solution for you! /sarcasm

  2. Sorry, Joseph, but you do NOT know how the Marketplace works, nor, SB, is it an hours-long ‘shopping trip. Here in Tennessee, the Non-Profit that is certified to conduct enrollments, goes through our State Marketplace for each person who applies and is approved, online. We have well-trained Navigators and CACs who help each person go online to and assist them in selecting the plan that they can AFFORD and that covers their health care needs. I have been involved since the first TN Enrollment sessions in 2013. The joy and relief from those who are finally covered, who can see a doctor, or in your case, Joe, even go to the ER, will not have to worry about a huge bill. Here in TN, we have enrolled over 500,000 folks who NEVER had coverage before, even for their children. The problem, as you mentioned, SB, is the Greedy bastards in insurance and pharmacutical industries. Three have already dropped their support of the ACA here in East TN….UHC, BC/BS and CHA because their CEOs were not making their usual profits on the enrollees. Example: My son-in-law, a small business owner FINALLY found a BC plan that was so affordable that he did not have to pay out of pocket premiums or co-pays. Now he will have to talk to Humana, the only insurance company left for us here. I just wanted to straighten up some of the misunderstandings of the ACA. SO, there you have it. So far, this ‘last’ enrollment here, we have enrolled over 165,000 happy and pleased citizens. And on the negative, seven rural hospitals have closed, some very ill patients have died because they didn’t make the minimum to qualify.

    • Mary, we aren’t talking about the Obamacare Marketplace, we are talking about the Republican “marketplace,” as in, the “healthcare marketplace” they say deregulation will magically create to replace the ACA Exchanges they are rushing to defund and dismantle.

      I will say this: the fact that Obamacare adopted conservative terminology/ideology on this always pissed me off. Because from day one we’ve all said healthcare can’t be viewed as a “marketplace,” and when everyone said you can “shop for health insurance” on the Exchange, I always said that was a really BAD selling point. If we were going to be tied to this system, at least adopt different termninology. Nobody wants to “shop” for health insurance. I’d rather have a root canal. Oh wait, I need insurance for that … never mind.

  3. Katydid

    I’m not crazy about my job, but the health insurance that comes with it is top-notch. I went to interview for a job that just ticked every box of mine for “the ideal job”, but the company’s insurance is a nightmare. The premium goes by the age of the employee and any dependents; my small family would be $1700/month. The money goes into an HSA, not directly into an insurance premium. When I pointed out that my family wouldn’t use $1700/month in healthcare unless something catastrophic happened, I was told, “That’s why HSAs are so great! You keep this ALL YOUR LIFE!” How, exactly, that works for dependents is not clear (that is, the $1700 would accrue under the employee…I think…?). Also, it would all be up to me to keep track of the balances and all receipts for “qualifying events” (which are likely to change over the years)….no, thank you. I didn’t take that job and told them why.

    • “You keep this ALL YOUR LIFE!”

      Yeah, my husband’s work briefly offered an HSA and we DO still have it because you DO keep it “all your life,” but as I stated elsewhere, unless you use it, the HSA slowly diminishes every month thanks to “management fees.” So you don’t actually use it but little by little, the balance gets smaller. It’s not a lot — maybe $5 a month or something? — but over “all your life” it’s all gonna go bye-bye. And yes, keeping track of everything is a PITA. You have to submit all that stuff when you do your taxes too so it’s just a huge headache.

      I know people who like them but I’ve never understood why.

      • Katydid

        My biggest concern about the HSA is how the hell does the average person even know how much to put away in a year? Even if all you do is go for a routine physical, it never costs the same twice. If you put too much away, you just lose it to management fees, and if you put too little away and something dreadful happens, you’re screwed as if you didn’t have it, so what’s the point?

      • Good point, and it’s never going to be enough if something catastrophic happens. And how is this different from just opening a regular ol’ savings account and saving money? It’s like they created them because in their heart of hearts they truly believe that anyone NOT THEM is just an irresponsible fuck who wants to waste their money on beer and blow and needs some stupid gimmick to be encouraged to save for a rainy day. It’s the Dave Ramsey Theory all over again. Stupid poors just don’t know any better.

      • Jim in Memphis

        Katydid – we have had an HSA as part of our medical coverage for several years now. The HSA fee actually drops if the value of the account gets high enough. The point of the account is for it to accumulate value over the years so when a big event happens you have the money to cover your high deductible for that year and then the insurance covers you.

        And SB, the difference is that any savings in the HSA are tax free as long as all proceeds are spent on healthcare related items such as medications, office visits, etc.

        When my company originally set up the high deductible plan that included the HSA accounts we saved enough on the premiums to make payments into each employee’s accounts for them. At the time it was the only affordable way that we could still offer health insurance for our employees as standard insurance was going through the roof (This was back around 2005 or so I think).

      • “the difference is that any savings in the HSA are tax free as long as all proceeds are spent on healthcare related items such as medications, office visits, etc.”

        Yeah I get that, which is why precise record keeping is such a pain in the ass. To get that tax deduction you have to have all of your receipts and records and it all has to be filed on April 15, as if people don’t bitch about taxes enough as it is.

        Basically all this shift to HSA’s is shifting the bulk of the costs away from programs like Medicare and Medicaid and employee benefit programs and onto the individual. Now *YOU* pay. And Paul Ryan thinks we’re all too stupid to notice. Hilarious.

        And as everyone with a brain has pointed out, it really only serves the well-off. If you are living paycheck to paycheck, you don’t have extra money to put into this account anyway. So that glorious “some day I’ll have a balance high enough to not pay fees” thing is totally unrealistic for millions of people.

  4. I know how to tweak the PPACA….

    More regulation. How else can we control premium hike grabs, runaway profits by insurance companies and hospitals, unethical billing practices? Inflated salaries? Amplified costs for simple procedures, tests and widely available cheap drugs by hospitals, ERs and LTC facilities? Money grabs by Big Pharma. Television advertising for dangerous prescription drugs? The only way to improve it that I can see clear would be massive regulation. This might involve some extra bureaucracy.
    I would think the republicans would favor letting Mr. Hand see what he can do first as far as competition and market forces. The truth is republicans have been playing to the people who can’t abide by their own costs going up a farthing just so that the uninsured can get in line to check in at the doctor’s office. They would honestly just as soon send them away empty-handed. Maybe if they got off of alcohol and cigarets they could make something of their lives.
    Let them eat cake.
    Oh yeah. I’m surprised that the stupid party isn’t crying tort reform on this one.

    • Of course you are correct. Seems like when I look at other countries, drug prices are kept low because of intense price controls. And there is heavy government involvement in healthcare delivery, either through a national health service like in the UK or the government picking up a large share of the costs, as in Japan. Nobody else seems to think that the healthcare is like a grocery store where you can let “market forces” determine what’s available, what it costs, and who has access. That is such a stupid idea.

      We are married to this system for the foreseeable future, un fortunately.

  5. K

    Why the thuglicans are pushing for sale across state lines is they can tailor a policy that gives miminuim coverage, as per it’s HOME state requirements, and then sell it across state lines but avoiding meeting other states standards or oversight,
    Also then the Ins. co. get greater freedom as to where the venue for any legal claim would occur.
    example is most of the Credit Card co. where, and may still be, based in Delaware because of specific laws and tax codes that fovor them espicially if an out of state claim got into court.
    So it would be for Health Ins. across state lines. Race to the bottom.

  6. K

    Off subject but I would like to acquire by legal means a GIF or such of the usurper dancing like a martionette in a clown suit, bells, whole thing and a script that anytime his picture appears on screen ( computer, Tablet would be nice) it would be replaced by the above mentioned GIF, or other common format.
    My wa may be at risk otherwise.