Fixing Healthcare?
There are a lot of questions floating around about healthcare, the ACA (Obamacare), the AHCA (Trumpcare), and the new Senate version of a response to the other two. Having worked for a while in the health insurance industry, I have a few points I'd like to bring up.
Many don't like the idea of paying healthcare costs for the poor through Medicaid. That seems to be one of the main Senate and House concerns in the legislative proposals. What does that really look like, however?
Several cities across the US in recent years have been tackling issues with regard to the social cost of homelessness centering around its impact of the expenditure of various public agencies. They looked at the cost of police departments, emergency rooms, social services, businesses, etc. Several determined that it was cheaper for them to provide housing for the homeless to get them off the streets and into a more stable environment than to keep on with the status quo. They determined to spend something like $1000 per month on housing and other services in order to save at least that much in ambulance rides, ER visits, police deployment, and the like. There is something similar to be said in regard to a safety net for other vulnerable segments of the population.
One of the great benefits of the ACA in reducing health care expenditures had to do with cutting down on ER visits by increasing access to preventive care. An ER visit easily costs some $10,000 and it is not designed to offer ongoing care for controlling blood pressure, diabetes, and other chronic health conditions. Once an individual has been stabilized and is not in imminent danger, they are released to seek follow-up care from a clinic or other physician.
What happens if the patient cannot afford that physician's visit? Blood pressure spikes after an initial prescription runs out if the medication ever regulated it at all. Blood sugar spikes without access to medication, insulin, or other treatment controls. A cardiac patient does not get continuing treatment and any of them likely shows back up in the ER for another $10,000 visit for which they cannot pay. Someone pays. The charges are covered by payments made by other patients, insurance companies covering others, and other social structures.
If the patient has a life-threatening emergency, they may qualify for emergency Medicaid. That means that those emergency visits to the ER may get billed to Medicaid at a much higher cost than ongoing treatment with a primary care physician. Medicaid funding gets hit harder than if the patient had Medicaid to begin with. Medicaid expansion and the ACA requirements were designed to help cover the costs to encourage ongoing treatment for chronic illnesses. Take that away, and the bill for all of us rises.
Rural hospitals are threatened by the failure of states to expand Medicaid. They accepted reduced payments for services, believing they would get more Medicaid patients. When expansions did not happen, they were placed in a bind. Many are now losing viability, making access to healthcare a greater barrier than before.
Insurance companies are still doing well. They are raking in plenty of profits, more so than are doctors and nurses. The pharmaceutical industry is doing very well, especially as Medicare and Medicaid are prevented by the Federal government from negotiating prices with pharmaceutical suppliers the way insurance companies can do. The medical technology industry is doing well, as are the companies cropping up to purchase physician offices, therapy clinics, and local hospitals. These players who are in the medical field for profit are raking in plenty of cash. The people who are not profiting nearly as well are those using the health care system.
Many are still complaining about being forced to buy medical insurance. Others are complaining about the rise in premiums. Still others complain they still can't afford to go to the doctor for treatment.
If I don't buy medical insurance, that does not mean I don't pay a cost. One of the benefits of the insurance is that when I go to the doctor I pay a reduced rate. Of course, I can also ask for a cash discount, but that can be hit or miss. I also pay a cost as I help underwrite the medical expenses of others who do not have insurance. In the event of something more catastrophic happening, however, I can go bankrupt from medical bills. In fact, before the ACA upwards of 60% of bankruptcies were due to medical bills, and many of those people actually had medical insurance. It just did not have the kinds of coverage the ACA now mandates. There were no maximum out-of-pocket limits. Instead, the insurance companies imposed maximum lifetime coverage caps to protect the insurance company profits.
Premiums were already rising rapidly before the ACA. Most people did not see this as companies paid most of the premiums and what might be billed as the employee's portion of the premium might be 5-10% of the cost. When companies figured out they would have to offer better coverage to anyone working more than 36 hours a week, they often cut hours or called employees managers to get around some of those loopholes in the law. Instead of keeping employees covered, they simply passed all of the cost of medical insurance onto the employees.
There is still a problem that many feel they can't afford to use their insurance. Part of the problem is that many did not understand the need to sign up for a Silver plan in order to get assistance with premiums, deductibles, and out-of-pocket maximums. Many do not yet understand the need to use an insurance agent who can help navigate the complexity of health insurance. It does not cost more, but it can save a lot of unexpected costs. Healthcare is still not free for most of us, but the protection we are getting makes sure that a trip to the ER does not mean bankruptcy, the loss of one's house or vehicle, and getting kicked out of the labor market. After all, the safety net is there for a reason, at least as long as we keep our social safety nets viable.
There is more than one way to resolve the myriad complexities of our healthcare system. Whatever route we take, however, it needs to address the need for a safety net for those who unexpectedly encounter a health disaster, whether as the victim of a crime, cancer, a car accident, or a chronic illness in concert with a loss of income. It needs to address that there are costs for the entire society when an underclass only has recourse to our most expensive forms of medical care, like our emergency rooms. It must take into consideration that holding lives hostage to profit margins is bad business, but it is also bad for the larger society. It must take into account that a thriving economy needs a healthy workforce. It must recognize that the good of the larger society also depends on taking care of our more vulnerable members.
It may be expensive to provide healthcare for our poor, elderly, children, and disabled. It is also expensive not to do so. In more than one way, it is less expensive to do the right thing.
http://www.sermonsearch.com/contributors/104427/
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