Healthcare is a human must. A sustainable high-quality health care system is the mark of a great society.
There is a lot of heated chatter these days about the Affordable Care Act (ACA) and its troubled implementation. Instead of coming together to make this critically important law work, the focus is on technical website issues, services not fully functional yet (like easy comparison of plans and determination of eligibility for subsidies), and the argument that anything and everything that ails us is “obviously” the fault of President Obama, ACA and Government. In addition, the great “horror of our existence” is that some plans in the individual market (under 5% of those with insurance) are being canceled by the insurance companies, most replaced with better plans to comply with ACA. (I found good options and with a little effort your will too.) Speaker of the house John Boehner declared last week that “We have the best health care delivery system in the world.” That is an inaccurate statement at best and I would urge him to read The Commonwealth Fund Commission on a High Performance Health System that outlines why we do not and how we can get there.
To put things in perspective, let’s evaluate our health care related standing in the world in the following categories:
1. Life Expectancy – America is 51st in the world with 78.62 years life expectancy. The 50 countries ahead of us with higher life expectancy include Japan #3 – 84.19 years, Canada #13 – 81.57 years, Israel #18 – 81.17 years, UK #30 – 80.29 years and European Union #37 – 79.86 years, all with some form of single payer organized health care system.
2. Infant Mortality – This is defined as number of deaths of infants under 1 year old per 1000 live births. America is 50th in the world with 5.9.
3. Teenage Pregnancy – Developed World – This is defined as number of births to women ages 15-19. In the US it accounts for 18.4% of all non-marital births and 8.4% of all births, making it higher than most industrialized nations.
4. Spending on Health Care – The US spends more on healthcare per person at 18% of GDP than any other country, yet lack of health insurance is estimated to contribute to 45,000 deaths per year as well as a factor in our shorter life span.
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As a participant in the individual insurance market for over 5 years now, I have, like many others, put up with ever increasing pricing, confusing/complicated terms and conditions, escalating out-of-pockets and deductibles and ever changing benefits and restrictions. Being healthy, I luckily did not end up like the hundreds of thousands of Americans (most with health insurance) in bankruptcy due to medical bills not covered by their sub-par plans, although I always have to pay for care in addition to and above my health insurance premiums. The Affordable Care Act was designed to reform that system and provides for minimum standards like:
1. Health Insurance Marketplace for people and small business to get competitive health care coverage.
2. No denial of coverage for pre-existing conditions.
3. Simplify and clarify what you are buying.
4. No arbitrary cancellation of insurance if you get sick.
5. Protect choice of doctors.
6. Cover kids till age 26 on your policy.
7. Include preventative care in all policies.
8. End lifetime and yearly dollar limits.
9. Guarantee right to appeal.
With those health care benefits, clearly some existing plans that come up wanting will be canceled. It was also clear that to maintain our health insurance system, we need to increase the pool of the insured with the young and those healthy of all ages, paying in substantially more than they take out. (That is how private insurance always worked and always will.) Meanwhile, the uninsured (numbered around 48 million people), now have the opportunity to acquire such protection and mitigate, with good coverage, the risk of losing it all due to lack of proper insurance or any insurance at all.
Why are we then laser focused on a small sliver of the US population that had policies canceled by insurance companies? And why is it that we fail to mention that those people who were always stuck in a “wild west” unpredictable market, now have the option to go on the exchanges (phone, mail and in person pending website fix) and find better and mostly cheaper insurance plans? For reference, California has already close to 60,000 people signed up, will meet its 2014 enrollment goal and just happens to be the largest economy and most populated state. (I guess, strong political will and appropriate allocation of resources and funding works!)
Let’s not forget that we have a for-profit insurance system that must pay out less than they take in to guarantee shareholder return. That requires both more “healthy” than “non-healthy” insured, as well as sub-par “catastrophic” policies that cost less but cover very little, if anything. With high deductibles and out-of-pockets and minimal coverage, most of those premiums are left safely in the pockets of the insurance companies. This also creates a chilling effect (preventing people from seeking early ongoing preventative care), which later forces them into emergency care (the single most expensive type of health care), at great waste of treasure and high cost of human suffering.
This is about Health Care, not Health Insurance. We all need health care on an ongoing basis and more of it as we age. We need to get the uninsured into the system and make sure we all have good health insurance, freeing us from living at the arbitrary mercy of the for-profit insurance industry. This will also curb the out-of-control escalation of health care as percentage of GDP.
A Public Option, of course, would capture the uninsured and incentivize the insurance companies to match or better the public option plans (capitalism and market competition at its best.) To go completely bonkers for a moment, I would argue that if we had some version of a Single Payer System, we would be able to deliver good health care to all Americans (focusing on prevention) at a reasonable price while reducing overall health care costs, as most modern industrialized nations do.
What is particularly disheartening with ACA (a compromise that did not make the Right or the Left happy), is the complete unwillingness to do any work on this in the House of Representative except repealing it (unlike Medicare Part “D” under the Bush 2 administration when all, Republicans and Democrats, joined forces to make it work), focusing instead on cheap politics and ideological fantasies that have nothing to do with the issue at hand.
Mitt Romney (and I am not a big fan), while campaigning for President famously praised the Israeli healthcare system, which provides high quality inclusive health care at a cost of 8% of GDP, compared to the inefficient and much less inclusive US health insurance system that costs a staggering 18% of GDP. (The basis of ACA is a Heritage Foundation plan, created to counter the Hillary Clinton initiative in the Clinton presidency and later implemented with great success in Massachusetts by Mitt Romney.)
There is no reason we cannot create a great Health Care System in America, except for lack of will. The first step to fixing our health care system is to fix the ACA implementation. What is needed is focus, motivation and leadership — right, left and center — putting people and country first and solving this critical national security issue that is the lack of high quality, affordable and cost-controlled healthcare for the American people. Congress and the political players and pundits should worry less about the “demise of the Obama presidency and its competence and credibility” (way premature and false), and more about making the Affordable Care Act work.
John F. Kennedy, who’s life we are celebrating at the 50th anniversary of his assassination, famously said: “Ask not what your country can do for you, ask what you can do for your country.” We should heed those wise words, take them to heart and take action to fix the implementation of ACA and provide affordable, high-quality and sustainable health care for all.
Tsach, you said “….a US Senator has responsibilities to the country beyond appealing to his base and it is our responsibility to call him on it.” Have you forgotten “we have to pass the bill so that you can find out what is in it,?” Specifics about ACA were never brought to America’s attention, so I guess that’s some of the rub. If people were allowed to see the bill in its entirety, perhaps these issues could have been addressed prior to implementation. No employer who provides employer paid coverage is exempt in that no matter the number of employees,… Read more »
Sorry the links do not work for you (don’t know what the problem is since I can’t replicate it nor can anyone else). As far as staying on the front page, the old has to make way for the new:) President Obama was talking about the majority of Americans that can keep their plans and the small percentage from the individual market had a grandfather clause (the problem was plans downgraded by insurance ci. after ACA was passed but before fully implemented). No doubt he could and should have been clearer and more specific about this bit I do not… Read more »
I’m actually more disappointed that others haven’t commented. Romney being a bully 30 years ago got countless responses but something that is on America’s front page ….. (sound of crickets)
I’m kind of disappointed that this article has been removed from front page. I still cant get the links to work, I’m redirected and when I click “site map,” I get an error. The reality is most small businesses will be affected. 66% of small employer plans will relinquish their grandfather status and will have to adhere to new regulations. So what’s the small employer going to do? Absorb the increase in premiums? Pass that increase on to the employee or simply stop providing coverage? UPS ended spousal coverage, is this a sign of things to come? Since you brought… Read more »
Hi Tom, Just tried all the links and they work. When you get a chance try again. Those without insurance are the uninsured, whether by choice or lack of funds. We all pay for them as insurance companies build it into the premiums and they also burden our national resources when they use emergency room as primary care. There was a time when car insurance was optional. Reality dictated mandatory insurance and in that case, depending on where you live, you can forgo having a car. You can’t with health care. We all need it and more as we age.… Read more »
I disagree with your assessment with what will happen with the employer provided market. As do many studies. That is where the additional cancellations will come from. We’ll see who is correct when things come around….
I’m sure you’ll discount this based on the source (Forbes) but they cite the administration’s own commentary regarding employer provided plans.
http://www.forbes.com/sites/theapothecary/2013/10/31/obama-officials-in-2010-93-million-americans-will-be-unable-to-keep-their-health-plans-under-obamacare/
Tsach … Thank you and same to you, have a good holiday as well. I tried the links you provided in your article but I’m getting error codes. The one link I was able to get through was that which described the “uninsured.” I remember going through this years ago when I was in the managed healthcare industry and Hillary Clinton was pushing for reform. As it was back then, one key component was left out of describing the “uninsured” numbers, or should I say conveniently left out and that is this. The uninsured who are only temporarily uninsured. The… Read more »
Tom, Your outlined experience is not substantiated by most who avail themselves on the state run exchanges in sates like Washington state, California (where I am) and Kentucky to name a few that got it done. What state are you in? Also, all the non-partisan studies I quoted with links so you can read them yourself disprove your claims of huge increases and actually show equalization between men and women for the first time on costs and benefits (insurance companies also tax deduct large overheads, much higher than Medicare for example). The issue remains the use of a for profit… Read more »
Did you seriously just ask if I was real? wow…just wow.
Based on my readings of various articles and the administration’s very own words- I am guessing we’ll see over 50 million additional cancellations once the employer mandate kicks in (of people who receive their insurance via their employers). I bet Tsach’s estimates differ. We’ll see who is right- I’ve been commenting here on and off for quite a while. I’d love to be wrong on this but we shall see.
I’m off to ponder my own existence (or lack thereof). Have a great Thanksgiving
Addressing the profit margins.. According to International Economic Development, the average profit for insurance companies hovers around 3%. Cato Institute says it’s more like 3.9%. According to a recent Forbes article with the ACA, the insurance industry is looking at “.. robust revenue growth and profits” Of course there is going to be an increase in profit. My wife and I are in our 50’s, my wife, due to censer, had all her plumbing removed. Yet if I were to have to purchase coverage through the ACA, our premiums would include a loading factor for OBGYN. This is just one… Read more »
My out of pocket max for the family is increasing from $10’000 to $12’700. Individual goes up from $5000 to $6350. Premium increase (for the 5 of us) from $521 per mo to over $1000 after December. And my plan had no coverage “limits.” $6000 additional in premium alone puts a real divot in our family’s budget. I do darn well but $500 per month is NOT negligible for us. This change on top of a few other looming expense increases has me seriously considering leaving my independent gig and going back to a high travel FTE role. Daddy won’t… Read more »
And life expectancy is not related to infant mortality. They are only linked in the sense that lack of appropriate care and prevention and healthy life styles impact both
I don’t think you undertstand how infant mortality rate data is gathered and calculated. I also don’t think you’ve bothered to look into it. This is a well known weakness with using infant mortality in comparatives across countries. The US data is incredibly skewed because any sign of life at birth is considered a LIVE birth. In other countries this is not so. Most European union countries do not necessarily count births before 26 weeks gestation. In Canada, Germany and Austria – birth weight below 500 g is not considered a live birth. Similar discrepancies in counting exist across ALL… Read more »
The issue we are discussing is health care vs. for profit health insurance. As I researched and substantiated, all other industrialized countries have a form of single payer health care system and their Citizens fare better in a long list of measures and their economies spend substantially less % per GDP than we do. To your points: 1. Infant mortality rates I quoted are measured the same way and this article claims a difference without any facts to back it up. 2. Insurance is about spreading risk since it is there to make a profit. You always pay for stuff… Read more »
“real insurance versus crap plans”- this sounds like one of the kids on r/politics. Items with an actuarial probability of ZERO shouldn’t factor in to an individual’s premium calculation. The ACA basically eliminates risk based underwriting. To some this is a good thing but if you want to talk about it you need to understand it.
By the way- the differences in how we calculate infant mortality also feed the discrepancy in life expectancy. Follow it all the way through…
The statistics don’t lie. I am glad your son is alive today but many more are not and cannot get that kind of care. You always had coverage you might not need. That is what Insurance is all about. There are tow aspects: 1. You might not get cancer but you want insurance to cover you in case you do 2. Risk is spread among all in the pool so you might never need certain kind of care but others in the pool might and true ij reverse. That is why every other industrialized country has some form of single… Read more »
First- You need to read up on the statistics you are citing. Most of these statistics are extremely misleading and this has been very well documented if you’re willing to read a little- http://usatoday30.usatoday.com/news/opinion/story/2011-10-03/infant-mortality-ranking-misleading/50647210/1 Kids like my son die every day in Europe. They dont even get counted as people. Second- I am very well versed on how insurance works. Cancer, your example, is a statistical possibility. Thats not what I am talking about. My family is now paying for things that we will not and cannot conceivably use. Here is a simple analogy- Imagine someone who does not own… Read more »
Have you looked at how the stats you cite are calculated? Infant mortality is an interesting one- dig a littler deeper and you’ll come to some different conclusions about our healthcare system. My son wouldn’t be alive today if he had been born ANYWHERE but the U.S. we try to save babies that don’t even get counted in the rest of the world’s infant mortality statistics (in most European countries the baby has to survive x days or hours to count as a birth. The international rankings are very misleading. Also, my plan got cancelled. My premiums will more than… Read more »