Going Backwards

The Senate’s “Better Care” reconciliation bill appears to be the shit-show we all knew it would be. You can read the non-partisan CBO report here. But I’m sure we’ve all heard the “22 million more uninsured” talking point which has come out of the report.

I feel like “22 million” doesn’t sufficiently illustrate the situation. So just to explain what this means: according to the CBO, there will be 49 million uninsured Americans if this reconciliation bill passes, compared to 28 million under the current law.

From the report:

Just to remind people: in 2008, when “the crisis of the uninsured” became a major issue in the 2008 presidential campaign, there were 47 million uninsured in America.

This bill doesn’t just take us back to the pre-Obamacare days, it makes it worse.

Carry on.

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:

1) I JUST WANT TO SEE THE DOCTOR OF MY CHOICE WHEN I NEED TO WITHOUT DRAINING MY BANK ACCOUNT. 2) I WANT TO GET THE PRESCRIPTIONS I NEED FROM MY LOCAL PHARMACY WITHOUT TAKING OUT A SECOND MORTGAGE.

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.

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?

“She Didn’t Ask”

Tennessee Gov. Haslam, who refuses to expand the state’s Medicaid program, preferring to let the state’s poor get sick and die (I suppose), while also claiming to have some kind of super-secret non-existent Tennessee plan that he’s supposedly “negotiating” (wink wink), and who recently was in the news asking HHS Secretary Kathleen Sebelius “to come up with a proposal that would give Tennessee more flexibility to expand Medicaid coverage,” could have asked Sebelius for an update on said plan today. Because today, Secretary Sebelius was in Nashville urging people to sign up for ObamaCare:

Sebelius was joined by Amy Speace, a 46-year-old singer-songwriter who was able to find insurance on the exchange for $30 a month with a $500 deductible, thanks to a tax credit. Speace said she did not at first think she would be eligible for insurance on the exchange because she already was covered by a high deductible plan through a musicians group. Despite that coverage, she nearly had to declare bankruptcy a few years ago when she developed laryngitis and ended up owing $5,000 in medical bills. She was only saved from bankruptcy by the help of a charity.

So, did Gov. Haslam meet with Sebelius for an update on that counterproposal? What do you think?

The governor told a reporter that he had no plans to meet with Sebelius when she came through Nashville on Thursday.

“She didn’t ask,” Haslam said.

I guess he just doesn’t give a shit.

Every day thousands of Tennesseans who lack health insurance face bankruptcy and worse. Gov. Haslam certainly doesn’t seem unduly concerned about those folks.

Good to know.

Obamacare Boosts Wages, Tennessee Proves

What’s that you say? It’s true, according to Dean Baker:

This is the “job loss” that has gotten opponents of the ACA so excited. But there is another aspect of this picture that should get other people excited. Back in intro economics we teach students about supply and demand. Other things equal, we expect a reduced supply – in this case of workers – to lead to a higher price or wage. In other words, a reduction in labor supply associated with the ACA might lead to some increase in wages.

We have an opportunity to test this proposition since Tennessee effectively did Obamacare in reverse, eliminating health insurance subsidies for low and moderate income adults without children in 2005. If the resulting change in labor supply has an impact on the market, then we would expect to see a drop in wages in Tennessee relative to other states.

That is in fact what we see. The figure below shows the median real wage for workers with high school degrees or less (the workers most likely to be affected) in Tennessee since 2000 compared to the workers without high school degrees elsewhere in the South.

Interesting idea. Also ironic that Tennessee kicked its low and moderate income folks in the teeth 9 years ago and saw a decline in wages as a result. It stands to reason that lifting up these folks will see a rise in wages. It’s sorta what people like Krugman have been saying since forever, but don’t expect the Republican’ts to start listening.

Identity Theft Memory Hole

It’s very amusing that people have suddenly discovered the identity theft issue, but it’s really annoying that they only seem to care about it in relation to Healthcare.gov. It’s not like your private insurance company doesn’t have all of this same information, folks, and it’s not like they are any less vulnerable to theft than Obamacare.

Let’s take a trip into the memory hole and go waay back to 2009. Oh lookie here: BlueCross BlueShield of Tennessee had 57 hard drives containing unencrypted client identity information stolen from a closet at its Chattanooga office.

Or how about back in 2007, when thieves stole laptops containing the Davidson County voter rolls — which include everyone’s social security numbers?

We’re always hearing about data breaches at places like Amazon.com and PayPal. I need look no further back than October 2013 when the State of Tennessee, which processes my paychecks, lost all of my information — not just social security number and passport number but also my freaking bank account number, because I signed up for direct deposit. All of it … gone. Not only did I not get paid for an entire month but now I have to worry about what the hell happened to this sensitive information. Probably nothing, but should I take this risk?

Wingers are going nuts about the Obamacare website exposing people to identity theft, but it’s not like everyone’s information isn’t available to thieves in a thousand other ways, too. Identity theft isn’t new, and it isn’t something Obamacare has brought on.

I find this incredibly annoying.