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November 19, 2013

"Affordable" Care Act

Many years ago, California passed laws that made having auto insurance mandatory within the state. The insurance companies looked at that legislation and said, "Great, we have a captive audience. Let's cancel policies, create new ones at many times the current costs, and screw as many people as possible, while making huge profits." (I'm paraphrasing.) While the intention of the state mandate was good, and, logically, the insurance companies would have had many more millions buying the existing policies, increasing their coffers a very respectable amount, they got greedy. California later then created and passed Proposition 103, which forced the insurance companies to rein in their greed. According to the Consumer Federation of America's report, Prop 103 has saved California drivers about $100 billion since it was passed, in 1988. California is also the only state where auto insurance rates have consistently gone down over the last 25 years.

The Affordable Care Act is a great idea. Allowing children to stay on their parents insurance longer? Great. Insurance companies not denying or dismissing your insurance for pre-existing conditions? Wonderful. Setting a baseline for the minimum amount of healthcare that plans will service? Stupendous. Getting rid of plan maximum payouts? Awesome.

But, like in California with the auto insurance, the federal government forgot some vital components:
  1. Setting insurance cost maximums for those base policies.
  2. Making it illegal for insurance plans to eliminate your insurance and then sell it to you again at higher rates.
Insurance works by having many people pay a small amount into a pooled fund. It is assumed that the majority will need very little of the fund and a small minority will need some or a lot of funds, so the majority pay for the minority and everybody pays a small amount total. The insurance companies get their profit from:
  • the amount of people in the fund, paying insurance premiums
  • the interest from the (assumed) amount of money that is paid in that is not paid out again.
Insurance is, in essence, the only legal pyramid scheme allowed, and all insurance works this way.

Health insurance companies could have looked at "Obamacare" as a huge influx of money into their coffers. They should have been lauding and trumpeting the passage and the subsequent Supreme Court rulings making it legal. Depending on which side you ask, somewhere between 15 and 50 million Americans would be added into the pool of those paying for health insurance. This would, by how insurance works, create more premiums going into its coffers and create more interest on the unused, larger amount of funds.

But, like in California in the 1980s with the auto insurance, the health insurances saw a way to make even more profit from Obamacare: in order to hit the baseline minimums that the Affordable Care Act insisted on, insurers simply eliminated a host of existing plans and then resold those people new plans that hit those base minimums but at a much higher cost to the canceled plans.

The minimums required by Obamacare are:
  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care
You may not need every single aspect (you might be male and single, and don't need maternity or newborn care, for example), but I think most people can respect that these are the bare minimums of things that should be covered by any insurance plan.

Let's say you had Plan X and it had 8 of the 10 minimums and charged you $50 a month. Insurers could add the two items you do not have to your plan and charge you, say, $5 or $10 a month more for the plan, which you would likely find reasonable and affordable. Instead, insurers are primarily choosing to delete your current plan, create a brand new plan with all 10 items, and charge you $100+ to rejoin. What do you get out of it: the exact same coverage, with one or two new coverages added, at double, triple, or more the original rate.

Now, let's say you are a health insurance company. You have 100,000 people with Plan X, paying $50 a month. You are getting $5 million a month from that plan, or $60 million a year. You are betting that less than 20% of your insured population will need to use these funds during any given year, and further betting that, of those who do need to, the majority are for low-cost circumstances (ER visit, kid has the flu, blood tests, medications, etc.). As an insurer, you can add those two missing items, charge the same people $60 a month, and start making $6 million a month. Because of Obamacare, you may also get another couple of thousand who didn't have insurance before who buy into Plan X. So, now you have 110,000 people at $60/month, or $6.6 million a month. You've increased your income by approximately 33%!

Instead, insurers chose to cancel the policies in full, force people to sign back up (with a strong likelihood they would, since the online registration rollout was so poorly handled), and charge them double, or more, for nearly identical plans. That is a money grab, plain and simple. Instead of being happy with the huge increase in profits that would come naturally, they made a grab for even more. And, what's worse, is that it is completely legal, because the politicians didn't consider that a corporation would take full advantage of a law like this, even though they had examples in fairly recent history.

Well, California is leading the charge again. They are proposing legislation similar to Prop 103 that would work the same way. I imagine it will have the same effect, too; insurance companies will continue to do business, will continue to make huge profits, but the people will have affordable rates and policies. No more raising rates by 170% over the last decade while inflation rose 32.5% during the same period!

Had the federal government thought to do this from the beginning, many of the people now without plans, and most of the people who were forced out and back into new plans, would have hardly noticed the Obamacare rollout. It would have truly meant only those people without a plan would need to work toward getting one.

There is absolutely no reason why the Affordable Care Act cannot work and work well. We've seen it work in more than one state and in nearly two dozen industrialized countries. Insuring everyone is a good thing, when done right. However, rather than learning from similar situations (like car insurance in California) or from the various ways that other countries have implemented it, America decided to recreate the wheel -- and did it badly. Insurance companies, which should have been helping every step of the way and thinking about all that new money that would be coming in naturally, got greedy. Politicians, rather than looking out for their constituents, made bad decisions (Democrats) or abstained from the process altogether (Republicans), rather than writing a law that made sense and closed these types of loopholes.

I hope that Obamacare continues because I know people with cancer and similar, expensive illnesses who need the caps on insurance removed. I know (and am!) people with pre-existing conditions that either cannot get healthcare or cannot get affordable healthcare because of them. I know people with insurance that doesn't actually cover anything, and I know people who have had their insurance dropped for no good reason except they had to actually use it, cutting into fly-by-night insurers profits.

Please, government, don't get rid of the ideas behind Obamacare -- just fix the broken bits with laws that make sense and keep the people in mind.

November 7, 2013

Back Pain, Again

I mentioned a little while ago that I had some severe back pain (here and here). Taking the advice of many family, friends, coworkers, and acquaintances, I pushed for an MRI before starting physical therapy. The issue, many of them explained to me, was that physio is great as long as you are being treated for the right cause. In many cases, however, they started physio right away and nothing worked or their back trouble got worse, because you do different physio based on the root cause of the problem.

The MRI was last week and I got the results today. Turns out that I have disc herniation in the L4-5/S1 area of my back, presenting on the right side. Which is exactly where all of my pain and discomfort came from. Even down to my right leg not wanting to make a full arc when walking due to the discomfort I still feel in it.

The herniation is NOT pressing on the nerve, which is great news, but the fact everything is swollen and not in line still causes a lot of pain and discomfort.

Now that I have a cause, I can go get the right physio for my situation. And my doctor is setting up a referral to a back specialist to review the case and make sure that nothing more is needed, like surgery or specialized treatment.

Hopefully, in a few weeks or months, I can post how my back pain is gone and my therapy worked. Now that we know the root cause of the problem.

Oh, and to the ass hat of an urgent care doctor that didn't want to listen, didn't want to know, and acted put out that I insisted on an x-ray, gave me bad pain medication, and refused to pay attention to my medical history -- I was right and you were wrong. Idiot. I don't know where he graduated in his class, but I can guess he failed the parts about "bedside manner."

November 6, 2013


I was bullied at times as a child. I was small, always something that bullies look for in a victim. I was a bit of a smart ass, something that bullies hate. I was one of the smart kids, something that many bullies can't stand. As someone who was bullied fairly regularly, I learned that there is never one set, pat answer to the bully. The correct response is fluid and changes with what is going on, how bad the bullying gets, the level of physical or mental trauma inflicted, and the level of threat in evidence.

The Incognito/Martin issue currently in the news, and constantly developing, really shows a dichotomy in how people think and see bullying. I was just watching ESPN and it was showing an exchange between Mike Golic and another former NFL player on the subject. Golic's response showed me that Golic has never, ever been bullied in his life (or that he believes one answer is right for all circumstances). He was basically saying, "Martin should have stood up to Incognito. He should have fought him and this problem would have gone away. Martin was weak to handle it the way he did."

Believing that you always stand up to a bully and doing so is the only correct solution shows a lack of understanding of the subject. While many bullies are in it for the physical (or mental) domination and having their prey stand up to them takes that away, not all bullies work that way. Some simply target someone for "fun" or some reason specific to the bully. Once targeted, the bully will do whatever it takes to stay in what they see as a position of dominance and control over their selected victim. If physical works, they use that. If the person stands up to that, they move on to emotional harassment, then maybe political control. They will lie to peers and those in power, even when the victim isn't around, in order to facilitate further bullying later. They will do things subtly, so if the victim speaks out or acts up, it looks like they are the ones at fault or having the problem, and the bully can keep right on doing it.

Add into this the level of sophistication and 24/7 access that today's technology allows a bully, and the abuse can be neverending.

When I was bullied, I had to determine which response was the best/right one for the current circumstances:
  • Stand up and take a beating (and hope to give one, too)?
  • Run away and live to fight another day?
  • Use quick wit and smarts to get out of it or away from it?
  • Take it to an authority and tell on the bully?
Each response has its Pros and its Cons. Each has a potential negative and may cause the bully to continue the attacks, or even double-down on them and make them worse.

With one bully, I stood up. I got punched in the ear so hard it started ringing and I thought his fist would come out the other side of my head. I kicked him in the testicles in return, and we actually became pretty good friends. In another case, I ran away; he had numbers on his side and I was likely going to get really messed up, but I knew I was faster than anyone in the bully's group, so I could escape that circumstance. I then had to avoid that bully and his gang until I figured a way to turn the tables on the bully and get back at him. Then he turned his attention on someone else. In another case, the bully was not physically imposing, but was mentally trying to dominate and control me. I had to use my wits to overcome this threat. And, on more than one occasion, I had to go my least favorite route and simply tell on the bully and see where the chips fell. In some instances, it went badly for both of us. In most cases, the authority figure believed me and the bully got taken down and had to move on to someone else because I refused to play the game.

In many of those cases, had I simply stood up to the bully physically, it would not have made any difference. Those who bully through emotional manipulation, lies, subterfuge -- they would have simply continued on, and probably increase their efforts, because they got the rise out of me they were looking for.

Another aspect that comes into play is the bullied person's temperament. A quite, shy, introvert is going to have a very different response and way of dealing with the situation, regardless of bullying type, than an extroverted, outgoing, confident person. The introvert will want to ignore it, at first, and then try to "go along to get along" second. He/she may finally feel either telling an authority figure or running away is the best course of action. An extrovert is going to confront first, and maybe use their wits, charm, and people skills to diffuse the situation. Both are valid responses, and neither is right or wrong. But what do these people do if their bully simply changes tactics and continues to come at them? That is when character is tested.

This is a very complex issue and one that cannot be solved simply by a physical confrontation. We are still finding out what went on between Incognito and Martin, so I cannot say how Martin handled it was right or wrong. Anyone who says that there is only one right way for Martin to handle the situation, however, I take exception to. Either they have never been bullied or they are completely obtuse to how bullying works.