"Only dull people are brilliant at breakfast" -Oscar Wilde
"The liberal soul shall be made fat, and he that watereth, shall be watered also himself." -- Proverbs 11:25
"...you have a choice: be a fighting liberal or sit quietly. I know what I am, what are you?" -- Steve Gilliard, 1964 - 2007
"Next time I tell you someone from Texas should not be president of the United States, please pay attention." -- Molly Ivins, 1944-2007
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I've always had health insurance. When I was in my early twenties and struggling to support myself in my own apartment on $8500 a year, I still got medical care. I'm lucky in that I've always been pretty healthy, so I've never needed a lot of care, but I've always gone to the gynecologist every year, and there's always been the occasional cold. Back then, paying for care happened in one of two ways: either the doctor's office would file the claim directly with the insurance company and then send me a bill for what wasn't paid (usually there was a deductible of about $100 or so), or else I'd front the money and then I would get an insurance company check.
Somewhere along the line it all changed, largely coinciding with the rise of the HMO. The HMO sounded like a good thing -- you'd have a primary care physician who was a "gateway" to any specialists you might need, but s/he was always in the loop. The problem was that your primary care physician had financial incentives to NOT refer you to specialists. But even if you weren't funnelled into an HMO, the network and co-pay became a part of every health plan with the creation of the Preferred Provider organization. Participating physicians were paid a "negotiated rate" if they were in-network, and there was an incentive to be in a network because fewer plans were offering out-of-network benefits. This meant that doctors had to see more patients to bring in the same income, and that led to the five-minutes-and-out medical practice that we see today.
And with all this, the cost of even basic healthcare started to skyrocket anyway. If you actually looked at your medical plan statements, you saw the regular office visit that used to cost you eighty bucks was now three hundred...and the doctor still got the same eighty bucks, branded as "usual and customary." Maybe you were making just a $20 copay every time you went to the doctor, but behind the scenes it was a very different story.
The problem isn't just health insurance company profits, though 2011 was the third straight year of record profit for the industry. After all, the goal of any corporation is to maximize profit and return to shareholders, and most health insurance companies are publicly-held entities. The problem is that health care is something that you need when you need it, and it's not something that you can safely "go without" if money is tight. Doctors should make a profit for performing services that require special skills and nonstop education. But what, exactly, do insurance companies add to the equation for day-to-day health care? Of course you need insurance for serious health issues and surgeries, but for those things for which most of us use the health care system, what do they really add compared to what they cost?
When I was laid off from my last job, it would have cost me $13,000/year to pay the full premium on the insurance policy that I have for Mr. Brilliant and me. This year the plan I had been in at my current job had a full premium of almost $16,000 for the two of us, out of which I would have had to pay $3800 in premiums. This plan is being eliminated next year, so I decided to bite the bullet, take the high-deductible plan with the Health Savings Account, and pay myself a good chunk of the premiums I would have otherwise paid to an insurance company. My preventive care is still covered at 100%, but the oral surgery I'm going to need is going to be subject to a $2750 deductible. That is the best scenario in today's health insurance market.
And this is where President Obama and cowardly Congressional Democrats screwed the pooch on the Affordable Care Act. But taking single-payer off the table right at the beginning, and then scrapping a public, nonprofit option just to get Queen Olympia Snowe, who complained yesterday that Obama hadn't been nice enough to her, to vote for the thing and allow it to be "bipartisan", led to the debacle we're seeing in the Supreme Court, where Roberthomascalito had clearly already decided to knock down the insurance mandate before hearing a single argument.
The rationale for the insurance mandate makes sense if you're going to assume that businesses whose goal is maximization of profit and minimization of cost are part of the equation. As with any insurance, it's all about spreading the risk around. The problem was in making for-profit businesses part of the equation in the first place.
I'm sure there are still those who believe that this whole theatre of "Obamacare" was part of the mythical Obama Eleven-Dimensional Chess Game, in which what he wanted in the first place was single-payer and once an insurance model is struck down, he can go back to the drawing board and get what he really wants. But if the word coming out of the White House is true, ACA really WAS what Obama wanted, and the White House Bubble has never even considered the possibility that an obviously partisan Court would strike it down.
The insurance industry is all ready to do whatever is necessary to sustain its profitability, because of its obligation to its shareholders. So it's going to be extremely difficult for this president, faced with a country full of parents of unemployed adult children, to explain why their children are no longer covered, and why he didn't fight for what was right in the first place, instead of trying to make nice with people who would string him up from the nearest tree if they thought they could get away with it. And as for Mitt Romney, well, if you have a pre-existing condition under a Romney administration and you lost your insurance because you lost your job, well tough shit for you:
During an appearance on NBC’s Tonight Show, host Jay Leno told Romney that he knew people that had never been able to get insurance before “Obamacare” was passed.
“It seems to me like children and people with preexisting conditions should be covered,” Leno noted.
“People with preexisting conditions — as long as they’ve been insured before, they’re going to continue to have insurance,” Romney explained.
“Suppose they were never insured?” Leno asked.
“Well, if they’re 45 years old, and they show up, and they say, I want insurance, because I’ve got a heart disease, it’s like, `Hey guys, we can’t play the game like that. You’ve got to get insurance when you’re well, and if you get ill, then you’re going to be covered,’” Romney replied.
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