"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.

ENT Response

Update:

Just heard back from the office. I can have my CT/X-ray scan at one hospital on July 17th and my hearing test and other stuff on August 8th at another hospital. They couldn't coordinate everything for the same day without pushing it well into August. Even still, I'll have to put up with the vomiting for at least almost another month, until I see the doctor for the review on August 8. *sigh
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Three weeks ago today I had my first appointment with my new Ear, Nose, Throat (ENT) doctor for my morning vomiting issues. When I sat down, he read off the referral from my GP which pretty much said, "Patient is complaining of throat irritation."

With my medical history, all the years of chronic issues, and with all that I explained to my GP when asking for that referral, I'm more than a little shocked that he did not include more than that in the referral. Needless to say, that did not start out the appointment on a good footing.

First, I explained the sensations I have in the morning that lead to the gag reflex kicking in and causing me to vomit or dry heave (or have to fight it off, rarely successfully). I then told him about the four medications I am currently taking, which led to explaining the chronic conditions I have, which led to explaining the hiatal hernia I have, which led to the multiple endoscopies I've had, which led to the ulcer in my throat I had.

My doctor said, "Well, that's one I haven't heard before" when I described the initial problem and, by the end, was saying, "Jeepers" under his breath.

In the end, he decided to schedule me for X-rays of my nasal passages, some sort of scoping of my throat and nasal passages, a hearing test (I've had ringing in my ears for decades), and a consultation. The office was going to do its best to schedule time for all of these on the same day, at the Regional hospital, so that I could come in and get everything done at once.

Needless to say, he had a full page of notes scribbled out by the time we were done. He went back to the original referral, reread it out loud, and then gave me a sigh and an eye roll. He mentioned something about possibly calling my GP and suggesting that one line wasn't really enough.

In the three weeks since that appointment, I have continued to have the issues. This week, for example, I have not been able to overcome the gag reflex and have painfully thrown up every day starting Sunday through this morning. Pretty much every time now I am seeing either blood or dark globs in my sputum when I throw up. I am certain this is not a good sign.

Since I haven't heard back from the doctor's office yet, I called and left a message (their answering machine kicked in when I called) for them asking where my appointment coordination stands. I guess telling them I'm throwing up every day wasn't enough to light a fire under them to get this moving. I will be explicit when they call back (or if I get ahold of him first).

I already have: problems with gum recession, my tooth enamel, my throat, and headaches. Each of those issues is getting worse with nearly daily throwing up, as the acids are hurting my throat worse, eating away at the enamel on my teeth, causing worsening gum recession, and the painful way this is whole-body heaving doesn't help my headaches.

Hopefully I will hear back from the ENT soon on the testing appointment. Sometimes I really miss my GP, Gastro, and Arthritis doctors from Southern California, as they knew me well, and would have gotten me in to see an ENT or for further testing within a week or two at the most from lodging my complaint. Here, they usually get you in for tests either after you've died or after whatever was causing issues is cleared up; either way, they can say they didn't find anything and move on. But at least it is "free" (and by "free" I mean paid for with a high income tax and double-digit sales taxes). *sigh

Reinventing the Wheel

I believe that President Obama is trying to make America a better place. I think that President Bush tried to do what was right for America (in my estimation, failing more often than succeeding, but still). However, in both cases, and with the Congress in general, they seem to be adamant about reinventing the wheel rather than seeing the wheels already made and picking one or two to serve as a model for what will work in America.

Take health care. There are, literally, a dozen or more examples of universal health care that American leadership could copy. Each of these examples has been proven over many years of successful use. We could send experts to Japan, Germany, Canada, Netherlands, Hawaii (yes, it has had a form of universal health care since the '50s which works great), and other nations, learn what works and what doesn't, and implement a plan based on those countries with a proven track record. Easy, right? No, instead we are going our own way, recreating the wheel in a hodge-podge of ideas that involve kick-backs and concessions to insurance companies and specific state lobbies. It will likely fail not because it is a bad idea but because it was poorly implemented.

Take banking reform. A number of banking systems were barely affected by the recent economic crash. Why not model the changes to the American system after the stable and secure systems of these nations (Canada, for example, et al) rather than making it up as we go and being reactionary to what happened, rather than proactive to making the system safe and secure? So far, at least, it looks like the changes being implemented aren't doomed to failure; I'm just not sure they will make the system safe and secure against the next threat to the economy.

Energy is another example where America could take notes from the rest of the world. Germany and Canada, for example, have multiple, much safer nuclear power plants using deuterium as their water source and which don't create the same weapons-grade cake that standard nuclear plants do. These plants have a great track-record and provide power to millions cheaply and efficiently. In America's quests to be energy independent, why aren't they looking at these types of power plants?

America has always been a leader to the world. However, in some areas, other nations have the proven track record and have discovered the efficiencies that America has not needed until recently. It would make the most sense if the country would take the best ideas around the world and implement those, rather than spending years and millions (billions?) to reinvent what already works.

Having Your Cake

So, the Republicans ask the President for a meeting to go over their ideas for health care reform. They ask it to be televised. He grants them both requests; matter of fact, he welcomes them. He schedules it for February 25. Now, Republicans are decrying the "trap" that the President has laid for them?

Er, what?

He has been asking for their input on health care since day one. He said in his original speech, basically, "if you have a better idea, my door is open." He basically said in the SotU address, "I'm still waiting to hear your ideas, if you have any. Door is still open."

They finally take him up on that open-ended offer, and he agrees with their conditions, and it is somehow a trap?

Of course, this is on top of the RNC having their meeting where one of the primary topics of conversation was how to defeat the President's health care agenda in the one state that has, in essence, federally provided 'universal health care' and it works beautifully and is something of a model for what the rest of the nation should have... Hawaii. Oh, and to all the RNC members who said it couldn't work long-term, Hawaii has only had this working for the past 40 years. I especially loved how the face of the Republican party, Rush Limbaugh has a health scare while in Hawaii and comes out of it with nothing but praise and goodwill toward the medical services he was provided... until it was pointed out to him that it was provided via a form of universal health care. Now he is decrying it, even though it didn't cost him a thing and he got excellent service (his words, not mine).

How can any rational Republican trust his/her representation when this is how they act?

Insurance "Debate"

If the President of the United States tells you to do something, you do it or make your very best effort. Right or wrong, good or bad, President Obama asked our leadership to come up with a plan for "universal" health care for all Americans, so that Americans can enjoy the same basic privilege of every other industrial nation. He outlined the following minimum requirements for this plan to be signed into law.

The Democrats, those of the same party as the President and the party with a majority on both sides of Congress, went to it with relish. They turned in a massive, bloated, and potentially problematic law that may not solve the problem, but at least covered what the President asked for in most ways. By all accounts, they tried to get Republicans to help with the plan and got a little bit of cooperation.

And the Republicans.... did nothing. Well, not nothing. They poo-pooed the plan the Democrats came up with, they poo-pooed the President and the President's proposal. Even after the President came right out and told them, if you have better ideas, we're open to them. Tell us. Prior to, during, and after the speech by the President and the Democrats creation of the bill, the Republicans have consistently and without conscious have lied about what the President said the bill should be and what the Democrats have come up with.

My parents taught me to take active participation in anything that is important to me. In this way, if I have an opinion, I can express it and possibly get my needs addressed in whatever is going on. Oftentimes, by expressing those opinions and needs, I am speaking for those who may not have a voice or feel they can speak up. Oftentimes, expressing these things changes the end result for all, but for the better of the group as a whole.

The Republicans have had every opportunity to be a part of this plan. To provide ideas and to constructively help this country in ways that will be immeasurable down the line to future generations. They have had every chance to look at the plethora of models around the world for universal health care, find the parts they like and are ideologically close to theirs and try to institute them. To come up with their own ideas and work them into the bargain. I'm certain that the Republicans help and ideas would have improved the plan the Democrats came up with in many ways.

Instead, the vast majority of them just want to sit this one out and make disparaging comments about everything and everyone involved. I see nothing constructive or helpful coming from them on this debate.

So, frankly, they must live with what is proposed unless and until they can come up with their own plan. Of course, nothing they come up with on their own will pass Congress without Democratic buy-in, so it seems like working with the Dems instead of against them would be best for both sides.

I used to be a proud Republican. I used to engender most of the party's ideals and beliefs. But the party slowly became exclusionary, ignored the moderates, voted based on hyperbole and fraction, and lied to me and the American people in general so often that I just couldn't align with them any more. Not that the Democrats were any better, mind you, so I disassociated from either party and voted my conscience based on the best information I could find.

The best info I can find on universal health care is that it can and should be cheap, easy, impact taxes and the economy of a national minimally, and should put the care of the individual in the hands of the doctor, not insurance companies. Canada is one of the world's worst models, yet they manage to do most of this. Japan, Germany, France, and other nations are paragons of what universal health care can and should be, and they hit all of these criteria. There are abundant examples of how this process can and should work, how it can be cost-effective, and how to keep the government out of the American people's health business.

Yet the Democrats are making the wheel anew, instead of looking to existing, working examples and modeling after them. The result is a bloated plan that may not serve the public in the best ways possible. The Republicans, meanwhile, are doing nothing except lying to the people, exaggerating the costs and effects, and throwing negativity at it without doing anything at all.

Is this what we deserve from our leadership, America?

Gas Stations

You live in a town with only one gas station, which sits on one corner of a crossroad. As this is the only gas station in the town, you are at the mercy of whatever the owner charges for gas.

Soon, a second gas station is put up on the corner opposite. The first gas station owner now has competition and must be more careful with raising rates and being competitive with amenities and other considerations, or you will start getting gas from the other gas station. However, there is still some chance for collusion between the two, as they are the only game in town and might find ways between themselves to increase their profits at the expense of the people who live there.

The town continues to grow and soon a third gas station is built on the third corner of the crossroad. Now, both existing gas station owners have competition from another gas station. The opportunities for collusion go down with more diverse ownership, and the competition for customers goes up. The people of the town have a lot more choice and can pick which gas station to use depending on their immediate or long-term needs.

Finally, the government steps in and builds its own gas station. It is a no-frills gas station, without bathrooms or any food/beverages, there are no full-serve lanes, and there is not a mechanic on duty. However, it can charge really cheap rates for gas. Initially, the other three owners cry foul because many of the town's people use the cheaper gas as an excuse to go to the new gas station. However, after the initial thrill of the cost, they soon realize they like having full-serve, even though they pay more. They like having a mechanic to look things over and fix their cars when something isn't right. They like getting food and beverages for the long trip ahead. Soon, many realize that it is worth the higher cost of gas at the other stations in order to get the service and amenities they want. However, those who simply cannot afford those other services continue to use the cheapest government-run gas station for what they need most-- gas to run their car.

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Now, replace "gas" with "insurance" and "gas station" with "insurance company/ies" and you have the health care debate explained in simple terms.

A public option will NOT raise rates or cause insurance companies to go out of business. It provides more competition and an additional, no-frills option for those who cannot afford more or better coverage. If you like your current insurance company and results, don't change. But if you think you need more, or less, coverage, you will have yet another option to choose from. Hopefully, insurance companies will then also create their own option in a similar coverage amount and cost to the public option, giving them access to more clients and more income -- which will further lower rates for all, as they have more clients and money coming in.

And, more importantly, if an insurance company drops your coverage (which is supposed to become illegal, but we'll see if the reality holds true to the desired goal), you have an option that cannot deny you coverage. For those with pre-existing conditions are very expensive treatments, this is a godsend.

Did Repubs Even Listen?

We picked up one physical newspaper and I have since looked at a few virtual newspapers online and I'm left shaking my head and bewildered at many comments made by Republican representatives in the House and Senate concerning President Obama's health care plan speech made earlier this week.

It seems like they didn't listen at all, as the vast majority of the statements made by the Repubs are diametrically opposed to what Obama said. Here are some examples, from The Denver Post:

"... what the Democrats' plan proposes is a government takeover of the entire health care industry that will force Americans out of their current plans and will have a tremendous cost that can only result in higher taxes and a larger deficit." Rep. Doug Lamborn.

"I heard loud and clear from my constituents this August that the current Democrat proposals are unacceptable -- they won't help reduce costs and they'll kill millions of small-business jobs." Rep. Mike Coffman

In no way did Obama's plan hint at a government takeover of the industry. In fact, he went out of his way to say and ensure that it was the opposite-- he WANTS insurance companies to be around for more competition and he specifically said in no way will anyone with insurance be forced to change or switch that insurance. He also said (and I am dubious of this claim myself, but I'm just reminding you of what he said in his speech) that a bipartisan group of economists believes they can pay for this plan without raising taxes and without increasing the deficit.

As to the second... I find it incredible that Coffman reps for a group made up entirely of psychics and prognosticators! They found a plan that Obama had YET TO PROPOSE OR INTRODUCE so unacceptable. Also, apparently none of them, or the rep himself, understood anything about the tax credits and incentives that Obama believes will make the plans affordable to small-business owners.

While I'm not entirely sold on everything Obama said in his speech, I find it ironic that so many reps of either house, primarily Repubs, are saying and doing exactly what Obama said they would do (and actually took them to task and said they shouldn't continue saying).

Shortly after the speech, Rep. Charles Boustany actually said in an interview "Replacing your family's current health care with government-run health care is not the answer" and he's right-- which is why Obama specifically said that is NOT what his plan will do, should do, or wants to do. Weren't you listening? If you could not listen to this simple, fairly straightforward speech and understand that, then how can you listen to your thousands, perhaps millions of people who you represent in Louisiana?

I have my doubts about Obama's plan. I doubt it can be done without taxes or without increasing the deficit. While I applaud the comments about cutting waste from the Medicaid and Medicare programs to help the funding, I am dubious about whether that can happen, how quickly, and how much money will be saved.

When he spoke of cutting "other programs" and "government waste" I cringed; the representatives of the states with these unnamed programs will fight for them hard and long and might make it impossible to rid our bloated government of this waste... especially is it may affect the Rep's pocketbook directly.

Also, on a couple of these key points that the Repubs seem to be most anxious, Obama specifically said he was looking for THEM to give HIM ideas and plans to solve the issue/problem he brought up within the framework of his overall goals... so why aren't they proposing their own plans? Why are they instead only saying that his plan will not work without saying what they would do that would work? If you want a say, and you want to make sure that the plan covers areas in which you have concerns, then DO something, SAY something positive to get the results you want, don't just poo-poo what is out there now.

The good things I got from Obama's speech:

• Making it illegal to deny a person from having or getting insurance due to pre-existing conditions. As one who has a pre-existing condition and lived a long time with that fear driving me, I know first-hand that no one should have that fear or pay those exhorbitant costs when changing jobs or fired from a job.
• Making it illegal for a company to drop or change coverage when you get sick and have to use the insurance. The entire point of insurance is to have it when you need it; the company underwriting your policy shouldn't be able to yank that out from under you just when you need it most and after you've paid hundreds to thousands of dollars into it.

Obama's goals and the plans he proposed are legitimate first steps in the direction toward a universal system. I think there are a lot of good ideas in those plans and goals and I think America should look outside her boarders at the many similar systems that work in other countries. Namely, I think America should look at the French, Japanese, and German systems of universal health care, each of which has a piece of the solution and would make for a good model of what is right and how to work it. Whereas as many of my friends and acquaintances point to the Canadian system as a plan, it does not work well, has huge delays, and requires taxation that Americans would never find acceptible, so should not be considered (except maybe for drug costs).

The one thing that Repubs are absolutely right about and that they should keep an eye on as the Dems move forward with their plans to meet the goals the President proposed is that competition is absolutely essential to making this work. If at any time any of the plans do away with competition (and, FYI, the President's planned "gov't option" was specifically and repeatedly mentioned as only one option, not getting rid of or interfering with any existing insurance options), it should be decried and denounced.

Until then, I suggest the Repubs take up the Dems and President's challenge and actually start thinking about and proposing ideas that will meet Obama's goals but are in some way more palatable to their thinking. It is time to either shit or get of the toilet and DO SOMETHING instead of simply playing devil's advocate and otherwise not getting hands dirty.