Health Care Reform: The Good, the Bad, the Ugly

[mijan]

The Good: 
- Private health insurance can't deny you for a pre-existing condition under this bill.
- You can't be dropped from a policy because you get sick.
- If you have insurance, they can't "cap" your coverage and say "you've been sick enough now, so we're not paying any more."

The Bad:
- It's not REAL universal health care.  YES, I am "one of those" who fully wants this backwards country to switch to a single-payer system like Canada's system.  I think anything less is a travesty - humiliating and ludicrous.  Time to join the modern world, people.
- Because it's not real UHC, this will do nothing to help the over-complicated network of insurers and the grossly high overhead costs of the health care system.
- Private insurance still rules our health care system.  I'm sorry, but for-profit health "insurance" is a crime against humanity, as far as I'm concerned.
- Nothing to attenuate costs of malpractice insurance, which is putting even GOOD doctors out of business, even if they've never been sued for malpractice.

The Ugly:
- Fining people for not having health insurance.  WTF?!?  I'm sorry, but for the self-employed to have to afford policies on their own when they're BARELY making ends meet... this is going to bankrupt many individuals.  That's STUPID.


Want to chime in with your thoughts?  Go for it, but no flaming.  Civil discourse, please.  Actual facts, please.  Insight from those who live in countries with UHC are welcomed and encouraged to share their experiences.

Comments

[scabbyfish.livejournal.com]

Okay, so I unfortunately know little-to-nothing about the US healthcare system (I'm in the UK myself *pets the NHS*) but Fining people for not having health insurance made me boggle enough that I had to comment. Just - what? I don't even. How is that logical? oO

[mijan.livejournal.com]

It's not. NOTHING about our system is logical. Not now, and not with the "reform" bill either. I'm not on EITHER party's side right now. They're all being stupid douche-bags.

[affreca.livejournal.com]

It is logical in the sense that it gets more people to play. In the current system, not having insurance is a type of gambling - will you stay healthy. If you do, you win because you don't have to pay anything. If you get sick (cancer, car wreck), you're screwed. You get to spend your own money until you run out, file for bankruptcy, get put one Medicaid, and hope that you get enough medical care that you don't die.

Supposedly, there will be subsidies to help poorer people afford insurance. I believe they are also increasing the number of people eligible for Medicaid.

So there is a logic to it, just not an obvious logic.

[gmonkey42.livejournal.com]

It's not logical at all, it's a sop to the insurance companies who are whining about not being allowed to screw their customers quite as much as they have been. The government actually forcing people to buy something from a private company: it blows my mind that they're getting away with this.

[affreca.livejournal.com]

Addressing the fining people angle - it is the stick to get healthy people to buy into the system, i.e. get everyone covered by some health insurance. Insurance works by having people without need of health care pay for those who do. The trick is that people change between those states, and often without warning. Those barely making ends meets are supposed to get subsidies to help them afford coverage, and it should protect them from going into bankruptcy when shit hits the fan.

Another way to think of it is that it would be the taxes you'd pay for a single payer system.

Downside is, I'm not sure there will be a self pay insurance option that will be affordable enough. Non employer insurance costs are highly variable (Lawnchair and I had a high dectuctable plan in KS at $120 a month for the two of us, but that was the perfect storm of KS low regulations and young people with apparently good health, vs. the thousands a month for COBRA I've known people to pay).

So, I don't know. There were some stabs at making the system better (using MA as the template). I'm afraid it was the best plan that could be passed. We'll see if it works.

[gmonkey42.livejournal.com]

The logical way to force everyone to participate in the system is single-payer, not this mess. It's infuriating that the government is so in the thrall of corporations that not allowing them to continue making obscene profits off human suffering is out of the question.

[mijan.livejournal.com]

I still think that forcing people to buy the product of a private business should be illegal, even with subsidies. I don't want my tax dollars subsidizing private health insurance companies. I want private health insurance to die a fast, painful death. It's a scam, even if everyone participates, because it's a for-profit system that makes money by denying coverage as often as possible.

Right now, an employed adult making $40K per year who can't get health insurance (which was me four years ago) STILL pays more for health care in this country than most people pay for health care in most countries with a universal system, whether directly or indirectly. Now, add to that the FORCED purchase of an insurance plan that the person can barely afford (who determines who gets subsidies?), and the fact that some insurance plans barely cover anything, and this is doomed to fail.

The single-payer system is more fair, more efficient, and not for-profit. So no, it's not "the taxes I'd pay for a single payer system." The overhead costs are still hideous. And while they can't deny people with pre-existing conditions under the terms of this new bill, they can sure as hell charge more! That's making me EXTREMELY nervous right now.

The ONLY logical solution is UHC, in the manner of a single-payer system.

[mijan.livejournal.com]

Also, you said that by forcing healthy people to participate, you make the insurance plans more viable to keep coverage for sick people. I say that's false, because at the moment, insurance companies KEEP healthy people and DROP unhealthy people from policies.

[gmonkey42.livejournal.com]

I agree completely.

Fining people for not having insurance just boggles my mind. "You don't have enough money for insurance so we're going to punish you by taking your money." WTF

[lurkitty.livejournal.com]

I am a strong proponent of UHC, and goodness knows, I've fought for it and will continue to fight for it. At this point, I'm not going to toss the baby out with the bathwater. I'm feeling like this is the vegetarian vs. vegan argument: both are steps in the right direction and we're arguing about incrementalism.

With respect to malpractice, I have argued and will continue to argue that the largest driving force behind malpractice suits is health insurance or lack thereof. First from the perspective of people looking at a lifetime of disability and no means of paying for healthcare to cover it, and second from the standpoint of insurance companies that force their policyholders to sue by denying claims if they don't. If everyone is covered, the first of those reasons go out the window. I am concerned that we'll still see the petty turf battles between which company should pay tying up courts, but I'm hoping that will decrease as well.

As to the fines, I don't like it, but I'm willing to wait and see given the structure of tax credits in place. If I look at it from the standpoint that those who willfully don't buy into the system when they have the money are jeopardizing it for the rest of us, yeah, I'd like to see them pay a penalty (the way that works is that we still have to pay for them when they have a heart attack or their kid gets hospitalized with the flu and they can't pay due to not having insurance). But I don't want to see anyone suffer that genuinely can't afford it.

[vampireanneke.livejournal.com]

It's bad, but better then what we have now. Atleast those who need coverage can get it. Those who have 'pre-existing conditions' can get covered. My older sister (as much as I hate her) has juvienial diabeties (found while with Kaiser). As such, even when my parents didn't have the option of Kaiser, they have paid seperately and have kept her on Kaiser. She continues to have Kaiser to this day because if she tries to go anywhere else they consider it an 'existing condition' and won't get anything covered.

It sucks to force people to get covered but it's stupid to not be covered. Because even if you don't have much money, that's when it seems something else is going to go wrong and you need the help. In southern california the uninsured are bankrupting hospitals, so much that ALOT of hospitals have now closed, meaning those with insurance are just as screwed. Alot of it has to do with illegals, and if it gets even 10% of the illegals to avoid hospitals (fear of fees and maybe deportation) then that's going to help the system out alot.

[emiliglia.livejournal.com]

One of the parts I like is that you don't get kicked off your parents' insurance until you're 26, now, instead of 23 before. Which doesn't help me at all but it'll help my siblings. I'm actually kinda getting screwed by it because I got kicked off at 23, didn't have health insurance for all of 2009 until I bought my own, despite being unemployed, in December, so it expires this coming December, but then next year I turn 26. *facepalm*

[gmonkey42.livejournal.com]

Oh that's good. I hadn't seen that.

and furthermore

[gmonkey42.livejournal.com]

In response to a few comments:

The problem with forcing people to be covered is there's no cap on how much the insurance companies are allowed to charge under this plan. As long as for-profit insurance companies are the only game in town (for most people, given most people aren't eligible for Medicaid), they will do whatever they can to avoid insuring people who will actually need their services: this bill prevents them from outright refusing to insure people but fails to prevent them from making policies for people with preexisting conditions outrageously expensive so nobody can afford them. Or from hiking up your premium so you can no longer afford it if you're already insured and you get sick. And then the government fines you for it. There is nothing to force insurance companies to offer affordable plans and there won't be.

What I don't like about this bill is it'll make it harder to make the changes that really need to happen. It encourages the mentality that "hey, they just made a bunch of reforms! We're fine now!" and there will be even more resistance to single-payer, which is what we need.

Re: and furthermore

[abusing-sarcasm.livejournal.com]

I believe I'm in love with you. I hope you don't mind. :)

Signed,

A self-employed person with numerous preexisting conditions who is scared shitless about how much her family will have to pay to become compliant.

[abusing-sarcasm.livejournal.com]

- Fining people for not having health insurance. WTF?!? I'm sorry, but for the self-employed to have to afford policies on their own when they're BARELY making ends meet... this is going to bankrupt many individuals. That's STUPID.

THANK YOU for providing a balanced commentary on this issue. I'm scared to death about how much we'll have to shell out for health insurance. I was in tears last night because I'm so worried about how this will impact our family. Right now, we are able to save and put money away for our daughter's future, but if we have to add a bill of several hundred dollars a month, all that's going out the window.

I understand that UHC raises taxes, but that would spread the bill so much more evenly amongst EVERYONE. With this plan, the burden is going mainly on the shoulders of people who can't handle it. I would LOVE to see a *real* health care plan that doesn't punish enterprising citizens.

*goes off to mope more*

[mijan.livejournal.com]

Hang in there, hun. I wish I could offer reassurance, but I can't.

Yes, UHC would raise taxes, but it would also mean that all the money that's currently being spent on our FAILED system won't be spent anymore! No Medicaid and Medicare necessary. No insurance premiums to be paid.

The biggest eye-popper is the amount of money spent by employers on their employees insurance. People who say "my employer provides insurance" miss the big picture. My employer covers 95% of my insurance premium. YAY, right? That means I only pay $22.68 per pay period. And then... wait a minute... so how much is ACTUALLY being spent on my premiums per year? $22,680 per year. On the premiums. And then how much more do I spend in co-pays and co-insurance? IT'S A SCAM. I'm not paying so much out of pocket, but I know where the money goes! I make $40K per year. If I made, instead, the entire $62,680 in cash, and then paid taxes at the same rate as my Canadian counterpart to pay into the single-payer system, I'd STILL be making more money, and at the end of the year, would have far more money left in the bank because co-pays and co-insurance payments don't exist in a single-payer system.

And now that I'm likely to be stuck with a diagnosis label that will follow me for the rest of my life, I can't imagine how much this would cost in the long run.

Yeah, I know where the money goes.

Yes, there were some good parts of the bill... but it's still an epic fail.

[neru-kudasai.livejournal.com]

Didn't they also take out the part that covers abortions?

[quiet000001.livejournal.com]

It's a Presidential Executive Order that says that federal money won't be spent on abortions. Which is sucky, but I suppose being an Executive Order means that it'll be relatively easy to get rid of when politics allow for it, without passing another reform bill.

[probing-grays.livejournal.com]

I also prefer UHC, but given how insane some people went over the current plan, that is just not politically possible at this moment.

Now, I am going to be the first person to admit that I have not been following this to the extent that I should, but I kindda understand the logic about fining people. One of the problems with health insurance is moral hazard -- that is, the people who are most likely to opt into health care are the people who are most likely to get sick, and healthy people are likely to opt out. This has been one of the reasons that companies have justified higher costs. If you make it mandatory, this no longer applies. It's also not requiring someone to purchase something private -- that's why there's a government-run program that people can opt into.

For me, the biggest thing that pisses me off is the restrictions on abortion. It's a legal medical procedure!

[rubymiene.livejournal.com]

The Ugly comes with the Good. You can't have the Good without the Ugly. Otherwise, people would wait until they were already sick to buy insurance, and while premiums are ridiculously high, they do not come close to paying for the full cost of case for someone to have surgery or a round of radiation or a lifetime supply of antiretrovirals. It is not stupid and it is 100% logical. Yes, I agree that single payer would be much better, but that is simply not possible. We will not have single payer until we vote out every single Republican in this country. This is much better than nothing, which is the other choice, both right now and for the next decade at least.
Furthermore, there is absolutely no way that requiring self-employed persons to buy insurance is going to bankrupt them. There is a cap of 8% of income. Subsides are available for those with income of up to $88,000 for a family of four, which is a pretty substantial amount. And the plan increases eligibility for medicaid, which means no family making less than $29,327 will pay *anything*. And none of the penalties kick in for 4 years. If it really looks like low- or middle-income families will be hurt, it can be retooled. Not to mention, the penalty is only $2,085 for four people! (and if you don't have insurance, you're probably going to be bankrupted by medical bills anyway, and those are going to be way higher than $500 a person)
Plus, the plan limits insurance company profits and encourages non-profit coops, and taxes insurance companies directly and taxes incomes over $250,000, all of which is good, progressive tax policy.
BTW, not long ago, I bought catastrophic insurance for a few months, and it cost ~$100 a month, so I think this is totally affordable for young people.

[flamewarrior.livejournal.com]

Oh, good - I was gonna post about the $88,000pa thing, but you got there first.

Not that I'm directly affected - I'm in the UK - I'm just really, really glad that the USA is taking a step in the right direction.

[coconut-ice22.livejournal.com]

Thank you for laying the facts out like this! I'm surprised they're planning to FINE people, that just seems far too heavy handed. Is there going to be, or is there, some kind of tax credit that helps in this area?

I work part time for a company who carried out surveys for the NHS on patient experience on hospital, and it really has enforced to me how despite the media here in the UK trying to tear down the NHS all the time, so many people are so thankful for the NHS. Of course there are complaints with a system like ours, my mum's been in agony for months waiting for an operation she really needs on her ankle. For many people, even those with private coverage in the UK, the NHS in an emergency is a top notch service that will not let you down, and you won't have to worry about the cost of the healthcare.

I've personally talked to and read the response sheets for thousands upon thousands of patients and the two most consistent complaints are probably about the food and the cost of parking. It does make me really happy that this is so!

Though at the same time people abuse the system a lot. My best friend is training to be a psychotherapist, the NHS pays for all her course fees and a bursary, and she already fully well knows that when she's finished her training she probably won't work for the NHS because of the dreadful wages. It has become something that a lot of people getting training on the NHS's penny do, especially dentists. Part of their requirement of the course is now usually that they have to spend x amount of time working for the NHS.

I don't think that any system is ever perfect but, as you said: for-profit health "insurance" is a crime against humanity and I couldn't agree more.

[quiet000001.livejournal.com]

From 10 years of living in the UK with someone with a whole raft of serious medical issues, my experience is that while the NHS does have flaws, it's possible that some of them are due to just the whole red tape/paperwork side of things, and people being willing to just sit back and wait.

I'm not saying everyone should demand everything now now now, just that the system is so big that sometimes things aren't communicated correctly, or whatever, and so if the patient or a patient's representative is willing to do some follow up and say 'hey, wait, that's not actually the situation' then it does help make sure the care and timing of the care is actually appropriate. (For example, the problem we encountered a lot was that the person in question had a very rare form of Muscular Dystrophy, which works differently to the more common forms; but often when an order or something was being handed over they'd just look at see "oh, MD" and make assumptions on that basis, which were incorrect for the care he actually needed. It's a totally understandable people issue when you consider the size and scope of the NHS - but it also means that you do have to kind of advocate for yourself - or your loved ones or whomever - a bit just to make sure things are happening as they should be.)

(And to be honest, with my experiences in the US, I think being willing to advocate for yourself or having someone with you who can do so is pretty much a necessary part of ANY health care system, just because at the end of the day it's all people, and people do make mistakes and have misunderstandings and so on.)

All of that said, of course, it was beyond amazing to have NHS coverage (since I have residency I got coverage) and know that I didn't have to worry about being in an accident, and that I could go see a dermatologist and a rheumatologist and even be sent to a physio who SPECIALIZED in my type of arthritis. I seriously did get a much better level of care there. (Some of which is down to, I am quite sure, the difference in regulations in the way pharmaceuticals are treated. In the US, EVERYONE is all about pushing the newest and shiniest treatment on me, regardless of the fact that an older treatment with side effects I know about and can deal with is still quite effective and successful at improving my quality of life. It took me FOREVER to find a doctor who'd just put me on what I'd been on in the UK, instead of trying to sell me on the latest and greatest and pooh-pooh my concerns about some of the Really Scary Side Effects. If the older drug didn't work, that'd be one thing. But it works! So stop trying to make me take something else just because the company is sending you pens and post-it notes!)

[fadagaski.livejournal.com]

The Good:

- your health system, such that it is, is so well funded that it will cope much better with an influx of new patients that the NHS did. We've been running to catch up with demand since inception.

The Bad:

- Obama had to agree to non-funding on abortion for this to go through. I think that's a shame, though I can see why he did it politically, and can only hope he doesn't go further on his own accord.

[be4u.livejournal.com]

The only fact I can add is YES, YES, and YES!!!!!!

I can only hope there are some additions/changes/tweaks in store, to fine tune the bill to fit real world examples like me.

[vixys.livejournal.com]

... fining people for not having health insurance? Now that's just a little daft. (Just a smidge.)

This does make you appreciate the NHS quite a bit. And I guess this is a step in the right direction? I mean, every system will have its flaws, and everything has to start somewhere. (And the US is comparatively young, I guess. :D Baby steps?)

I don't get why people are opposed to UHC, though. There are flaws in the NHS (not enough funding, not enough beds, blah blah blah), but you can still get healthcare when you need it - and why's that a bad thing?

Anyway. ♥

[baby-werewolf.livejournal.com]

About the only argument I've heard is that the NHS is ~socialist~ and therefore evil.

[baby-werewolf.livejournal.com]

The main thing I got from hearing all the debate on this is that I'm really glad to live in the UK with the NHS, because wtf kind of stupid system did you guys have before this bill?
All the changes you've listed under 'Good'...why the hell could they ever get away with those things? I don't see quite how anyone ever got any healthcare, if they could drop you from a policy for getting sick or not give you one in the first place if you are sick.

I agree that this bill doesn't go nearly as far towards a fair and logical system as it should - but given the level of opposition to these changes, a sweeping changeover to a single-payer system would never have gone through. (Why, I don't quite get. People are strange and don't make sense)

Still trying to wrap my head around insurance companies ever having the right to drop you from a policy because you get sick. What is the logic in this? You have health insurance to cover you for when you get sick.

[aliciajd]

I retired at 52 and bought private health insurance in 2002. At that time my payments ran about $320 per month for $2500 deductable, with 80% covered once the deductable is met. But, I was lucky to get insurance at all because I'm 'obese' by actuarial tables. Nebraska has a requirement that insurers must insure uninsurables, although at a much higher rate. In the 8 years since then, my insurance rates have gone up considerably each year, even as coverages are drastically reduced each year at renewal time.

I now pay about $790 per month for $7500 deductable. The lifetime cap has been dropped from 5 million to 1 million and the list of items that are not covered or that are covered at a lesser percentage grows ever longer.

Have I mentioned that I have never met my deductable, as my health has been very good so far?

Basically, I'm paying $9500 per year for nothing!

I'll be fully eligible for Medicare before much of this bill kicks in. Personally, I'd like to outlaw health insurance companies and go with an extension of Medicare top to bottom. The criminally misleading anti-bill advertizing that the industry has done during this campaign ought to be sufficient grounds to ban them from our country entirely.

[kaymyth.livejournal.com]

Personally, I'd like to outlaw health insurance companies and go with an extension of Medicare top to bottom.

FL Rep. Alan Grayson has actually already introduced this bill to the House. It's essentially a "buy in" option to Medicare for everybody. You pays your premiums, you gets your Medicare, all for an at-cost price. It's simple. It's awesome. It's four pages long.

But, of course, the insurance companies will rail against it, as they'd be completely fooked by this sort of competition. Poor babies.

[supasass.livejournal.com]

I'm generally happy about the health care reform cos it seems to be the most any government is at all willing to do. Obama, the Change and all, seems to be totally against UHC. At least theres slightly less chance of american human beings dying in the waiting room as the cheque clears?

I'm from Britain and more than ready to pound the streets for the NHS despite it's problems. For example, because I have diabetes I get free access to all and any medicines I need. This is saving me £432 a year. It's not perfect - it doesn;t cover all chronic diseases such as mental illness, and the general allocation of resources to mental health is highly disappointing.

Nevertheless, NHS came along just after the 2nd world war and its like the whole country engaged in this act of selflessness that hasn't happened in Britain at any other time in history. It's the best of us.

[weepingnaiad.livejournal.com]

It's a long, long way from perfect and I really do feel like all the money the insurance companies spent on lobbyists paid off for them, but not for us, but it is a start, an acknowledgment that health care is not a privilege but a right.

*hugs*