Healthcare In America - Where Do I Begin?by Author / Marc D'Agosta
Healthcare In America - Where Do I Begin?
Copyright 2017 Marc D’Agosta
This essay remains property of the Author.
All rights reserved.
About the only advantage of being broke is that you actually get to see how the healthcare system works. Most people, including the politicians and media, really don’t seem to give us a complete understanding of how the Affordable Care Act really works. Where do I begin? How about with what the Affordable Care Act actually does?
Besides preventing healthcare providers from denying someone coverage because of a pre-existing condition, and requiring these insurance companies to provide a comprehensive package for care, all the Affordable Care Act really does is help you make the payment on the premium. That’s it. A person chooses from the same private health insurance policies that are provided if that person were to go directly through the private health insurance company on their own, rather than the government. The only difference is, if you go through the private health insurance company directly, you pay the entire premium on your own; if you go through the government, the government helps you make the payment with subsidies--tax payer money that actually goes to the taxpayers, rather than primarily into the pockets of the wealthy with reckless tax breaks--reckless to the economy, reckless to the debt, reckless to our good health, and that really only buy the rich a greater luxury. But if footing the payment on a trillion dollar loan for a billionaire is what you really want to do, that is the right you have as an American. However, consider this, since President Obama and the Democrats repealed the Bush tax cuts for the wealthy in 2013, and even with the Affordable Care Act being on the books as law since 2010, the debt has been reduced--a true indicator, it’s not healthcare that wrecks the country economically--it’s the tax breaks for the wealthy that wreck the country. And incidentally, even though congressional legislators and their staff purchase their healthcare through the Affordable Care Act, and other federal workers buy their healthcare through the Federal Employees Health Benefits Program, the formula is the same--the government pays up to the lesser of 72% or 75% in subsidies towards their premium with regard to the type of plan and who is on the plan they choose; and if the Republican congressional leaders repeal the Affordable Care Act, they and their staff will most likely again be able to choose from the Federal Employees Health Benefits Program for their healthcare, while those they cut off will be left with nothing.
Now, the politicians and media often bring forth these complaints with our current healthcare system. You can’t choose your own doctor. The rates are too high. Co-payments and deductibles are too high. Nobody likes the mandate to buy into healthcare, or if you don’t--pay a fine later when you do your taxes. There are not enough young people signing up and buying into the pools, so healthcare providers want to pull out because they can’t make money or cover costs without the young folks. Also, a government public option would put private health insurance companies out of business and cost people jobs. And forget about even considering a single payer system. Well, let’s look at these points, and how health insurance companies really make their money.
As far as choosing your own doctor--what determines whether or not you can choose your own doctor has nothing to do with the Affordable Care Act. What determines whether or not you can choose your own doctor is the type of health insurance policy you choose. If you choose an HMO plan, most likely you will not be able to choose your own doctor. Why? Because your own doctor no longer takes HMO plans. Doctors like everyone else want to get paid. HMO plans don’t pay. If you choose a PPO plan, which is more expensive than an HMO…yeah, you’ll probably be able to choose your own doctor. Why? Because your own doctor takes PPO plans. PPO plans pay. It’s that simple. So not being able to choose your own doctor is on your own doctor, not the Affordable Care Act; and unfortunately, again, comes down to the rates you are willing to pay, or can afford. Therefore, let’s take a look at rates.
Rates. What drives up rates? Not what, but who? Health insurance companies! That’s who drive up rates, because that’s who still determine the rates you pay. It’s not the government. It’s not the Affordable Care Act. It’s healthcare providers. That’s why the mandate to buy into healthcare doesn’t work. It’s healthcare companies who dictate the rates. What healthcare providers do under the Affordable Care Act is give you a group of private comprehensive health packages you can choose from based on age and income, and then all that is mathematically worked out to determine what you will pay, and what the government will pay in subsidies. For example, if you are in no man’s land, like I am, meaning between the ages of 50 and 65--too young for Medicare, too old to get a decent rate to be properly covered--the healthcare provider I went through gave me three packages--a gold, silver, and bronze--and it’s a bit like the Olympics--gold is really great; silver is still pretty good; bronze--well, at least you medaled. The gold package provided comprehensive care, a low co-payment, a low deductible, but the premium was through the roof. So, chances are, if you are going through the Affordable Care Act, even with the government kicking in subsidies, you will still be too poor to afford this package, as I was. The silver package provided the same comprehensive care, a little higher co-payment, a little higher deductible--but still both reasonable. However, the premium, though not reaching the height of the gold package, still went through the roof, and was still out of realistic reach for anyone going through the Affordable Care Act. Finally, the bronze package…well, not bad, not great. A premium just barely within reach. However, a ridiculous co-payment of nearly a hundred bucks per visit to your primary care physician, along with a six thousand dollar deductible. Yet, it did provide comprehensive care, though as President Trump described while campaigning--really only good for if you get hit by a truck. But the way I figured it, if I got hit by a truck, at least I would be covered. So improvement does have to be made to the Affordable Care Act. But you don’t kill it. And solution comes with understanding what the business of healthcare really is all about.
The Affordable Care Act is not the biggest problem with healthcare. The biggest problem with healthcare is that it is an industry, when it should be a civil right. Healthcare companies are not in business to provide a person healthcare. Healthcare companies are in business, like any other business, to make money. A friend of mine once told me, health insurance is like a bet--you’re betting you’ll get sick, while healthcare companies are betting you’ll stay well. And that’s exactly how healthcare providers make their money, and why these companies are so very eager to kill the Affordable Care Act. Like the Republicans are proposing and passed in the House with their healthcare bill, or really lack of healthcare bill, to replace the Affordable Care Act, health insurance companies like to sell consumers cheap plans with cheap coverage. They want people to buy health insurance with a low premium, so that they (private health insurance companies) will only have a minimum to pay out. They want a person to pay this low premium month after month after month after month and so on--hopefully for years without ever having to use it. However, you don’t accumulate any points with the many times you pay the premium. You just get what you bought into--a minimum amount of coverage. And if you do use it, healthcare providers usually increase your rates. That’s how health insurance companies make their money, like any other business--taking in, more than they put out. And being required to provide comprehensive care by law isn’t something they can really afford, or make money off of. At least with the current way of their thinking. This is why it seems like health insurance companies manipulate a catch-22 like scenario--keeping rates high for young people, then turning around and complaining young people are not buying into the healthcare pools--what appears to be an ingenious method to kill the Affordable Care Act. And an example of why healthcare providers are so eager to kill the Affordable Care Act and sell cheap insurance with cheap coverage is that if a person or a loved one (even a young person) becomes afflicted with a serious injury or disease, the amount of coverage the health insurance company will be on the hook to pay out will be capped. They can just walk away, leaving you, the person who bought into cheap coverage, to have to pay the rest out of pocket. Treatments, medications, operations won’t be covered. The minimal amount put into the government vouchers that the Republicans promise will also be zapped dry. A father or mother will have to go into their savings, the kids’ college funds, or even to the great extreme of selling their home, because the bills will mount into the hundreds of