“Unless You’re One Of The Unlucky Ones”: Americans Suddenly Discovering How Insurance Works
It’s been said to the point of becoming cliche that once Democrats passed significant health-care reform, they’d “own” everything about the American health-care system for good or ill. For some time to come, people will blame Barack Obama for health-care problems he had absolutely nothing to do with. But there’s a corollary to that truism we’re seeing play out now, which is that what used to be just “a sucky thing that happened to me” or “something about the way insurance works that I don’t particularly like”—things that have existed forever—are now changing into issues, matters that become worthy of media attention and are attributed to policy choices, accurately or not. Before now, millions of Americans had health insurance horror stories. But they didn’t have an organizing narrative around them, particularly one the news media would use as a reason to tell them.
The latest has to do with the provider networks that insurance companies put together. This is something insurance companies have done for a long time, because it enables them to limit costs. If an insurer has a lot of customers in an area, it can say to doctors, “We’ll put you in our provider network, giving you access to all our customers. But we only pay $50 for an office visit. Take it or leave it.” An individual doctor might think that it’s less than she’d like to be paid, but she needs those patients, so she’ll say yes. Or she might decide that she has enough loyal patients to keep her business running, and she wants to charge $100 for an office visit, so she’ll say no.
So every year, doctors move in and out of those private-provider networks, and the insurers adjust what they pay for various visits and procedures, and inevitably some people find that their old doctor is no longer in their network. Or they change jobs and find the same thing when they get new insurance. And that can be a hassle.
But now they have someone new to blame: not the insurance company that established the network, and not the doctor that chose not to be a part of it, but Barack Obama. It’s not just my hassle, it’s a national issue. As Politico reported, “Speaker John Boehner (R-Ohio) said to reporters on Tuesday that the ‘fundamentally flawed’ health care law is ‘causing people to lose the doctor of their choice.’ Chief GOP investigator Darrell Issa has launched a House probe into the doctor claim. And House Republicans have highlighted the physician predicament in their weekly GOP addresses.” So to reiterate: Your insurance company set terms for its network that your doctor didn’t like. Your doctor decided not to be in that network. And that, of course, is Barack Obama’s fault.
Before we move on, there’s something we should note. You know who never loses their doctor? People who have single-payer insurance, that’s who. If you live in pretty much any other industrialized country in the world, you don’t have to worry whether your doctor accepts the national health plan that insures you and everyone else, because every doctor accepts it. Even here in America, there are people who almost never have to worry about losing their doctor: the elderly people who benefit from America’s single-payer plan, Medicare. Despite their constant gripes about payment levels, 90 percent of doctors accept Medicare, because there are just too many Medicare patients and doctors don’t want to be shut out of that business.
“Obamacare will make you lose your doctor!” may be the attack of this week, but conservatives are even trying to blame Barack Obama for the basic way insurance itself works. There’s a lot of talk about what a raw deal Obamacare is, a message that’s being aimed at young people in particular to try to convince them to stay uninsured. As Jonathan Cohn says, “The simplest way to describe Obamacare is as a transfer from the lucky to the unlucky.” That’s not just true of Obamacare, it’s true of insurance generally. All insurance.
The way insurance works is that unless you’re one of the unlucky ones, in purely financial terms, your insurance costs more than you gain from it. Have you ever sat down with all the bills you’ve paid for car insurance and homeowner’s insurance and totalled up all your premiums and all the payouts you’ve received over your lifetime? If you did, it would probably look like you paid a lot but didn’t get much in return. Some people who have had major catastrophes—an accident that totalled their car, a tree falling on their house—come out ahead, but people who haven’t had those things happen to them come out behind. If it wasn’t that way, every insurance company would lose money. But they don’t. They work very hard to set premiums to exceed the amount they spend in payouts (not to mention working hard not to pay out for things they ought to). But as Jonathan Chait says, “Insurance isn’t a kind of gamble where you bet you can beat the house by consuming more in medical care than you pay in premiums and deductibles. It’s protection from risk. People like that protection. They will pay to acquire it.” That applies not just to health insurance but to every kind of insurance. That’s why it’s called “insurance.” (The only exception is life insurance, which works more like an investment.)
The only people who come out ahead in dollars and cents on insurance are those people who have had terrible things happen to them. What the rest of us are buying, as any insurance salesman will tell you, is peace of mind.
To get back to the place we started, it can seem now that people are saying for the first time, “Wait a minute! Insurance is a raw deal! I mean, Obamacare is a raw deal!” And the media are doing their part by running stories that characterize the side effects of the private insurance market, like limited networks of doctors or the fact that less expensive plans have higher deductibles, as something new that’s occurring only because of the Affordable Care Act. But they aren’t. If you want to have a system of private health insurers, that’s how it has worked in the past, and that’s how it will continue to work. If you really want to be free of those problems, you’ll have to wait until you’re 65 and can join the big-government, socialist plan called Medicare.
By: Paul Waldman, Contributing Editor, The American Prospect, December 10, 2013
“A Sordid Approach To The Uninsured”: Republican’s Increasingly Appear Eager To Punish The Poor Because They’re Poor
Even if the Affordable Care Act is implemented perfectly, and the system works exactly as planned, millions of Americans will go without access to affordable health care. Is it due to a flaw in the law? Not exactly.
The problem is Republican opposition to Medicaid expansion at the state level. If your income is between 100% and 138% of the poverty line, you can qualify for Medicaid and get covered – unless you live in a “red” state where GOP officials have rejected Medicaid expansion. If so, you can (a) move; (b) figure out a way to make more money; or (c) go without.
Just in recent days, we’ve seen reports reinforcing how inexplicable these states’ policies really are. Refusing Medicaid expansion will not only cost states billions, but it will also severely undermine state hospitals, all while hurting struggling families.
Kevin Drum today called it “one of the most sordid acts in recent American history.”
The cost to the states is tiny, and the help it would bring to the poor is immense. It’s paid for by taxes that residents of these states are going to pay regardless of whether they receive any of the benefits. And yet, merely because it has Obama’s name attached to it, they’ve decided that immiserating millions of poor people is worth it. It is hard to imagine a decision more depraved.
Alternatively, Republicans in Congress could agree to fix this problem and allow people without access to Medicaid to qualify for exchange subsidies. But of course they won’t do that either for the same reason.
Conservatives hate it when you accuse them of simply not caring about the poor. Sometimes they have a point. This is not one of those times.
I strongly agree, though I’d just add that it’s amazing to hear Republican governors who reject Medicaid expansion try to present their approach as sensible.
Wyoming Gov. Matt Mead (R) recently said he refused the policy because he doesn’t like exchange marketplaces, which doesn’t make any sense. Alaska Gov. Sean Parnell (R) justified his opposition by saying the health care law is a “mess,” which is shallow even by GOP standards. Wisconsin Gov. Scott Walker (R) appeared on MSNBC and said he rejected Medicaid expansion because, someday, federal officials may “renege on their promise” to reimburse states.
Has that ever happened? No. Is there any reason to believe it might happen? No. Could Wisconsin bring coverage to struggling families in the meantime, and then drop the policy in the event Washington refused to meet its obligations? Yes, but Walker doesn’t want to.
The larger takeaway here is that Republican officials increasingly appear eager to punish the poor because they’re poor. Indeed, it’s become a common theme in GOP policymaking just in recent weeks: no extension of unemployment benefits, no extension of the status quo on food stamps, no increase in the minimum wage, and wherever possible, no Medicaid expansion, either.
Republicans better hope low-income Americans vote in low numbers in the near future.
By: Steve Benen, The Maddow Blog, December 9, 2013
“Obamacare’s Real Promise”: If You Lose Your Health-Care Plan, You Can Get A New One
The furor over “if you like your plan, you can keep it” touches on a deep fear in American life: That your health-care insurance can be taken from you. That fear is so powerful because it happens so often: Almost everyone in the country can lose their health insurance at any time, for all kinds of reasons — and every year, millions do.
If you’re one of the 149 million people who get health insurance through your employer, you can lose your plan if you get fired, or if the H.R. department decides to change plans, or if you have to move to a branch in another state.
If you’re one of the 51 million people who get Medicaid, you could lose your plan because your income rises and you’re no longer eligible or because your state cut its Medicaid budget and made you ineligible. You could lose it because you moved from Minnesota, where childless adults making less than 75 percent of the poverty line are eligible, to Texas, where there’s no coverage for childless adults.
If you’re one of the 15 million Americans who buys insurance on the individual market, you could lose your plan because your insurer decides to stop offering it or decides to jack up the price by 35 percent. And that’s assuming you’re one of the lucky people who weren’t denied coverage based on preexisting conditions in the first place.
Then, of course, there are the 50 million people who don’t have a plan in the first place. The vast majority of them desperately want health-care coverage. But it turns out that just because you want a plan doesn’t mean you can get one.
Virtually the only people whose health coverage is reasonably safe are those on fee-for-service Medicare and some forms of veterans insurance. And even there, enrollees are only safe until the day policymakers decide to change premiums or benefit packages.
President Obama’s critics are right: Obamacare doesn’t guarantee that everyone who likes their health insurance can keep it. In some cases, Obamacare is the reason people will lose health insurance they liked.
What Obamacare comes pretty close to guaranteeing, though, is that everyone who needs health insurance, or who wants health insurance, can get it.
It guarantees that if you lose the plan you liked — perhaps because you were fired from your job, or because you left your job to start a new business, or because your income made you ineligible for Medicaid — you’ll have a choice of new plans you can purchase, you’ll know that no insurer can turn you away, and you’ll be able to get financial help if you need it. In states that accept the Medicaid expansion, it guarantees that anyone who makes less than 133 percent of poverty can get fully subsidized insurance.
Health insurance isn’t such a fraught topic in countries such as Canada and France because people don’t live in constant fear of losing their ability to get routine medical care. A decade from now, that will be true in the U.S., too. But it’s not true yet, and paradoxically, that’s one reason health reform is so difficult. The status quo has left people rightly fearful, and when people are afraid, change is even scarier.
By: Ezra Klein, Wonkblog, The Washington Post, December 8, 2013
“A Nightmare For John Boehner”: Why Obamacare Could Help The Democrats In 2014
If some Republicans are sounding just a little bit desperate right now, I think I know why. “Obamacare is not just a broken website,” House Speaker John Boehner sputtered the other day in retreat as it emerged that the website is now working well. “This bill is fundamentally flawed.” He sure hopes he’s right about that—and by the way, Mister, it’s a law, not a bill. But I bet late at night, when he’s having that last smoke and thinking back over his day, he fears that he’s wrong and that the central Republican…“idea,” if you want to call it that, of the last three years—get rid of Obamacare—is going to look awfully stupid to a majority of Americans eight or 10 months from now.
If you haven’t gone to HealthCare.gov just for kicks, I certainly recommend now that you do. Pretend that you’re from a state that didn’t create an exchange, if you aren’t, because if you’re from a state with its own exchange, you’ll just be kicked to the state website, and what you want to test here is the federal one. So just choose a yahoo state that didn’t play ball, where the law was mocked as just so much socialism.
I just did, for the first time in weeks, an hour before scribbling these sentences. I was amazed. It was lightning fast. Explanations were clear and straightforward. Instead of bureaucratese, I encountered something I didn’t expect at all: plain English!
And here’s the key thing. It gave me loads of choices. I pretended to be a 35-year-old man from Kansas with a spouse and child. Without even having to enter my fake income, the site delivered me in a split second to a page with loads of plan options.
Choice. That’s what America’s about. As I heard Sen. Joe Manchin (D-WV) say on Alex Wagner’s show a couple of weeks ago, we’re a nation of shoppers. It’s what we do best. Alas, he is correct. That’s what we want. From TVs to smartphones to flavors of potato chip that have been stretched to include ketchup and dill pickle (who eats those?), we believe that endless options are our right.
How many options? An amazing 42, to be precise. Forty-two plans! That might be more than the number of available potato-chip flavors in America. I would have to think it will shock people, in a highly positive way, to see they have so many choices. And most of all, it will feel…American. Something that offers a person 42 options ain’t socialism, as Americans know in their bones.
The plans ranged from $70 a month, which would have covered only me, to $742 a month for the Rolls-Royce family version, with $0 deductible and $6,500 out-of-pocket. It was an astonishing menu. And take it from a guy who just moved house and has been on the phone and online interminably with private-sector service-providers, mostly but hardly limited to the cable/Internet/phone company: This looked easy. The interface was great, really user-friendly, really clear.
Now, most of these plans weren’t cheap. Health insurance isn’t cheap. For example, a middle-of-the-pack silver plan looked like this: $472 a month; a $7,500 family deductible; a $12,700 out-of-pocket maximum. Those aren’t cheap. But a $10 copay for a doctor’s visit, $75 to see a specialist, and just $15 for a generic prescription. That’s not bad at all.
So yes, Mr. Speaker, it’s more than a website. It’s a chance for people who’ve eschewed insurance for years to buy it and take their kids to a doctor and even to a specialist when needed. Individuals will have to decide for themselves whether that buys them $5,664 in peace of mind (that’s $472 times 12), but I suspect a lot of people will decide that it sure does.
And this is where Republicans, if they’re looking around the corner, might be freaking out. They are going to emphasize the horror stories going forward, and those stories will exist. The Democrats will emphasize the violin stories, and they will exist, too.
But in between the decontextualized disasters and the stories with Hollywood endings will be millions of people to whom nothing particularly dramatic, but something very positive indeed, will have happened. They got insurance, or decent insurance, for the first time in their lives. They went and got their first physical in years. They had that bad back checked out finally. They took their child to an eye doctor and got her glasses. That’s not dramatic enough for a television ad, but any parent will understand that a child going from struggling with reading to being able to read easily at school is plenty dramatic.
I’ve known for a long time the Republicans were on the wrong side of history here. Forty-something million uninsured in this impossibly rich country, and they don’t want to do a thing about it. And don’t fall for their “plans.” They’re unworkable. They’re unworkable because the Republicans aren’t willing to spend the money that experts all say is required to make plans workable. And they aren’t willing to spend the money because spending money acknowledges the existence of a common purpose in this nation, and they certainly can’t acknowledge a common purpose, unless it’s war.
So while I’ve known they were on the wrong side of history, I have feared they were on the right side of the politics. Well, I’m starting to think otherwise. No American who has 42 choices is going to feel like the jackboot of the state is stomping on his neck. And sometime next year, the people in the states that didn’t take Medicaid money are going to start noticing something else: that in a lot of cases, they’re going to be paying more for the same plan that a person in a participating state is paying. How’s that going to go down, Rick Perry?
Mr. Speaker, light up another one. It’s going to be a long night.
By: Michael Tomasky, The Daily Beast, December 5, 2013
“Oh Ye Of Little Intelligence”: Rick Santorum Wins The Prize For The Worst Nelson Mandela Tribute
ObamaCare is a great injustice, much like the institutionalized racism and segregation of post-colonial South Africa, according to former Pennsylvania senator and failed presidential candidate Rick Santorum (R).
In an appearance on Fox News with Bill O’Reilly Thursday, Santorum likened Mandela’s anti-apartheid crusade to Republicans’ continued efforts to dismantle the president’s health care law.
“He was fighting against some great injustice,” Santorum said, “and I would make the argument that we have a great injustice going on right now in this country with an ever-increasing size of government that is taking over and controlling people’s lives. And ObamaCare is front and center in that.”
Leaving aside the fact that shanghaiing a world leader’s death to peddle your political beliefs is gross opportunism at its worst, Santorum’s comparison is flawed for another simple reason: Mandela was a prominent proponent of expanding access to health care, especially for the poor and disadvantaged.
From a South African department of health report on the nation’s health care system:
On the 24th of May 1994, President Nelson Mandela announced in his State of the Nation address that all health care for pregnant women and children under the age of 6 years would be provided free to users of public health facilities. The free care policy at primary care level was extended to all users from 1 April 2006. [DOH]
Free public health care? Sounds like socialism to me.
There’s more.
South Africa’s constitution enshrines a “right” to health care in the same subsection that it guarantees the rights to “sufficient food and water.” The Kaiser Family Foundation named an award after Mandela honoring “the efforts of individuals who make extraordinary contributions to improving the health and health care of the most disadvantaged sectors of the population in South Africa and internationally.” And Mandela’s work, both in office and after, laid the groundwork for South Africa’s new universal health care system.
We’re sure Rick Santorum will be issuing a retraction any moment now.
By: Jon Terbush, The Week, December 6, 2013
Share This Blog
Unknown Feed- An error has occurred; the feed is probably down. Try again later.
mykeystrokes.com 