What a Fine Mess

I really wanted to address the Great Affordable Health Care Debate, and I will try to to a very limited extent, but I am telling you right now after two weeks worth of study and research I am just flat not smart enough to understand what the intricacies of this whole mess add up or subtract down to.

And since I personally know many of the faithful readers of my blog, and while I respect you all and value your opinions and friendship—even those of you whose new hobby is hating me—I don’t think any of you are smart enough to understand it completely either and at least one of you is one of the smartest human beings on the planet with stuff hanging on his wall that says so.

                How did it get to be such a mess?

 Obamacare did bring 10,000,000 people into the world of health care that weren’t there before whether they wanted to be there or not.  I know the more popular number is 24,000,000 but that is a made up estimate that we weren’t supposed to hit until 2020 and even the CBO’s current numbers of 18,000,000 people who will be tossed to the curb and left to die in the cold includes at least 8,000,000 people who don’t exist yet.

And that’s part of the problem: both sides are using “alternative facts,” “fake news,” and a dump truck load of rhetoric that avoid the tangible issues, obscure what really are facts to the point you can’t tell what’s real and what’s estimated and just generally confuse the public to the point nobody knows what the heck is going on.

I recently watched a PBS debate (I know, I can’t believe it either) between two alleged experts—Lanhee Chen (pro-republican health care bill) and Dr. Ezekiel Emanual (anti republicans being on his planet)—and after I watched it I went on line and read the transcript.  I am convinced I am even dumber on the subject than I was before I listened to these two clowns interrupt each other for 15 minutes.

It all seemed so simple when President Trump laid it out in his address to Congress:

             1.       New health care legislation must protect and benefit ALL Americans.

2.       Pre-existing conditions should be covered.

3.       Tax credits on a sliding scale and HSA’s made available to all if they so choose.

4.       Medicaid should be all-inclusive and be administered at the state level.

5.       Protect patients and doctors from artificial costs by bringing down inflated drug costs for the former and putting torte limitations in place for the latter.

6.       Allow insurance buy-ins across state lines to bring down the cost of insurance and increase the amount of health care an individual gets for his or her dollar.

So how did we get to nothing getting cheaper until 2020; subsidies for insurance companies; insurance premiums for those over 55 being four to eight times higher than youngsters; threats about Medicaid shutting out needy folks (again, the rhetoric on that one drowns out what may actually be real and dangerous) and everybody being mad at everybody else?

And quit screaming, “Because Donald Trump hates poor people,” if you’re on that side of the fence.  Your factless, meaningless noise is just contributing to the problem.  Produce an actual, thoughtful answer and quit parroting what Bill Maher says on his comedy hour or whatever his show is supposed to be.

Personally, I don’t think the problem is the cost of health care for most people as much as it is the cost of health insurance. That may be a horrible answer to anything but it is thoughtful and carefully considered.

Let’s say you just had a hip replacement and the total bills came to around $50,000. (Except for the sneaky bastard anesthesiologist who bills you 30 days after you think you’re safe and you owe him $1100 more that your insurance isn’t going to pay.) If you look at all your statements $50,000 is one of the most made up numbers in this whole debate because your insurance will only allow about $10,000 and the medical providers (except that a-hole anesthesiologist) all say, “OK.”

You then are left paying $1500-$2500 (or $6500 if you had Obamasurance) plus 10 or 20% of the balance up to whatever your maximum is. Oh, unless you belong to a union or work for the government in which cases you have never seen an insurance premium or paid anywhere near those numbers for anything and don’t understand what the fuss over Obamacare is all about in the first place.

It sucks, but providers will work with you and you can handle it. Or you could if you weren’t paying so much for your insurance premium so that you had enough cash to pay your part of the bill.

I think for most Americans the real problem has been the cost of the premiums, but this issue is so complex and multi-layered I totally understand and expect there are those who disagree with me. My wife and I pay $6,156 out of pocket more per year (over and above what our employers can afford to pay) for less health insurance coverage than we did two years ago and at that time it included our daughter. That is enough money it affects other areas of our lives and we don’t like it.

I don’t want to sound selfish and say that we shouldn’t be helping out those who need it but it seemed like we were already paying plenty in taxes, most of which goes to one entitlement program or another in this country and $6100 hurts.

Now our legislators are looking at reform that doesn’t mention HSA’s or make clear how tax credits may work; doesn’t mention torte reform or the ability for insurance companies to compete across state lines; and does raise premiums for older folks, continues to subsidize insurance companies and screws with Medicaid if you can believe the talking heads on TV and even though I am predisposed not to do that I’m hearing enough of it it frightens me.

Now we’re told that perhaps the most sensible and necessary part of bringing down the cost of health insurance which was to allow insurance companies to compete across state lines is going to be part of “Phase III” of health care reform. A phase most “experts” don’t think we’ll ever get to.

I think somebody should think again and instead of offering the insurance companies subsidies, say, “Sorry Blue Cross, you are now subject to the laws of capitalism and a free market. Figure it out.”

If you let the free market set the price of health insurance I don’t think we’ll even need tax credits to help people afford it. Capitalism left alone will fix most issues of cost.

                I think portable HSA’s should become as incentivized and encouraged as IRA’s and 401k’s (these are pension alternatives for the rest of us in case you’re in a union and don’t have to deal with our reality). I think states probably should have control of Medicaid but someone needs to tell us what that really means without letting Nancy Pelosi talk for just a second.

                I think pre-existing conditions should be covered but should be stripped out of the affordable health care act so it quits hanging up the rest of the bill which we need to deal with now.  Handle pre-existing conditions in their own bill in a way that doesn’t break the backs of insurance companies but which doesn’t cause them to need subsidies either. Yes, we’ll have to subsidize it another way, maybe even as another (may God forgive me) entitlement program.

                And I think there should be a torte cap on malpractice lawsuits that brings down one of the largest and scariest costs for most medical providers as well as enforcement of anti-trust regulations upon drug manufacturers to keep epi pens and such from costing more than a car. (And yes, I know I am hypocritically suggesting we take big Pharma out of the realm of the free market, but if they’re going to be poop heads that’s the way life goes.)

                I told you I’m not smart enough to understand all this. But I am smart enough to be angry when I’m being hurt. And this is all just what I think, which once again my liberal friends, qualifies me to be an Associated Press hard news reporter but does not obligate you to believe or agree with me.