Health care

What's coming with Trump and the Republican congress in terms of health care? I don't know.  As usual he speaks out of both sides of his mouth and probably has no understanding of it at all. Not that Obama understood it when he was pushing for it, but, I doubt Trump has ever really talked about it with anyone who knew the basic plan.  

I still look for some signs that the ACA was a good law and I can't find it, other than for the obvious - some people getting free or actually affordable health care who could not before benefit from it and society benefits from that too.  I've asked a number of people who I think have a clue (that is, not your average person who reads newspaper articles) who support it and I'm still not persuaded by them. It seems to me the following "facts" are true. Correct me with a reference to something I can read (and, um, understand) please: 

- Insurance coverage today is just a few percentage points greater than the pre-recession baseline.

- DHS predicts that less than half the number of people the CBO predicted to be in exchange based plans were actually covered as of last March.

- The large majority of the people signing up will be older and sicker than your average person.

- Premiums, deductibles and co-pays for plans are sky rocketing for many (not everyone - and mine are reasonable - I generally benefit from the law; nevertheless, I am also generally against it). The basis for increases being a "one time correction" is not deductive reasoning but a prediction like any other. And it doesn't seem to include tax increases like the huge Cadillac tax in 2020.

- In 2016, health care costs rose by the greatest percentage since 1984.

- The Commonwealth Fund (which is pro-ACA) analysis found that the CBO initially overestimated exchange enrollment by 30 percent, its costs by 28 percent, and underestimated Medicaid enrollment by about 14 percent. If the CBO has understated the problems and costs, we could be in trouble, because most of the employment issues that will arise were predicted to be coming post 2016.

- About 3/4 of those without insurance still say they cannot afford it.

- Only 5 of the 23 co-ops remain, all failing within 3 years. Of the remaining ones, all posted losses in 2015 and of the few that had gains in 2016, they have to make health risk adjustment payments under the ACA and at least one is suing over it.

- Almost one of three U.S. counties now has a single insurer offering plans.

- Some proponents of the plans are suggesting that we have to double funding. If it is successful, why?

- Last Gallup poll I see, from 8/2016, only 11% of Americans were very positive about ACA and 23% more somewhat positive against 30% somewhat negative and 24% very negative. Asked generally, it is 51 to 44% negative. 29% to 18% thought the law hurt them.

- A  Kaiser Family Foundation poll in 2015 showed of politically independent doctors, 58-42% were negative about it (partisan doctors were pretty much like their political groups). I will add that anecdotally, I haven't spoken to a doctor or nurse that told me they liked it. 

- There is no indication that the "tinkering" that was said to be necessary has helped any of the above.

- A WaPo (generally pro-Obama) article claimed that Republicans are falsely claiming double counting to find Medicare A viable. Here's how they defend it:

"(Note: Some Republicans have argued that the administration “double-counted” the savings from Medicare in order to fund Obamacare. For complicated reasons we've explained before this is an acceptable government accounting practice that both parties have used to calculate the solvency of Medicare. A strong case can be made that there is no double-counting going on at all. It’s simply a case of looking at the same money in different ways. In other words, it is not double counting, but counting different things.)" It could be that I'm just biased but that sounds awfully weak to me.

None of the above includes the usual criticisms about the mandate, unfair waiver provisions, subsidies actually paid for by income redistribution, the admitted lies (you can keep your doctor, your health care plan, etc.) or the political sausage making that led to passage. 

One thing that was clear to me since it was passed. Once you give protection to those with pre-existing conditions and those 26 and under living at home, you are not going to get re-elected by taking it away. I have also thought they were laudable goals if we can find an affordable way to do it (not the way it's being done). Contrary to what I hear, it seems that the Republicans do have a plan or plans. I can't tell you if they are good plans at all. Not being a fan of big government plans in general, I doubt it. We also know that given the huge infrastructure of the ACA, there is not going to be repeal without a replacement.

I don't mind writing these posts without having answers. But I've always floated one on this topic - that we should make a special tax credit (not deduction - credits are better) for those who will pay other people's health care - either one to one - A gives to B or to some type of exchange, that is, A gives to a gov't agency or co-operative earmarked only for health care for those who can't afford it. Perhaps it might even be better than a dollar for a dollar. The usual criticism I hear when I float this is that it cannot possibly pay for the entire health care system. Of course, I never suggested it could. But, I wonder if it would not only pay for those without coverage, but if we would actually have to limit it so that it did not drown out other charitable giving.

I heard another one that makes sense and I am looking for criticism of it. Steven I. Weissman,  who claims to be a former president of a Miami Hospital (which one he doesn't say, but from what I can find online he is a lawyer who ran a acute care facility for a while - doesn't mean it is not a good idea), has a petition on change.org entitled "end predatory healthcare pricing," which calls for an end to hospitals charging different prices depending on what health insurance you have or worse, if you have none. He claims, and I'm not sure that is true, that it is the only service you buy where this happens (I know that is not true of my own profession where attorneys sometimes change price based on who the client is, charging less to those who can afford less or who has referred them, etc.). I think it is largely true. I have twice experienced a medical professional - in one case a doctor and in another case a lab, seek to charge me many times what they would charge an insurance company. Since I hadn't contracted with them (and didn't know they were separate entities servicing me - long stories) I refused to pay more than an insurance company would pay, which was obviously reasonable compensation. He also points out it will end the burden of having a doctor in or out of networks, as they won't be able to vary the price.

I'm not sure what value either his idea or mine will have, but, they are good ideas that will not take a tremendous government network to run. Some people feel that is necessary these days. You'd have to convince me and I haven't been convinced at all.

I had the usual big-government-controlling-our-little-lives nightmare the other day. I am on Obamacare in NY. You don't have a choice if you aren't in a business that has a plan. The plan itself is not bad at all and I do not complain about the cost, which is reasonable. But, I do realize that this is because of other people paying more and everyone paying more taxes and I'm  generally against my having a benefit at other people's expense that isn't available to everyone - and it's not. Someone said to me a couple of year's ago, so you can't complain about Obamacare because you have it. This is a little bit like someone telling you that you can't complain after a shotgun wedding. I didn't have a choice. In NY, you are either on a business plan or you are on an exchange plan. There are no other options.

In any event, my plan, a platinum plan, has automatic re-enrollment. At the end of 2015 after a barrage of emails, I reluctantly took the time to re-enroll, only to be told, as expected, it had happened automatically already. 

This year, I did the same thing - went online to re-enroll after being told I would have no insurance, only to get a response that I was already re-enrolled.

So, I paid my premium before the end of the month as always. It cleared a few days later, meaning it was deposited by my health care company. I also got an email from them in the new year. But, when I went to use it, I was told by my pharmacist it was cancelled. 

So, of course, I called the next day. Well, the agent responded, you were re-enrolled automatically, but . . . the exchange cancelled that plan on 12/31/16 - New Years Eve. Didn't you get an email? No, I said, I just read all my emails.  You have a new plan and it is going to cost you only $31 and change. Okay, I say, first, thanks to everyone for the warning. Great system you all have. Second, there is no way in the world I am going to have to pay only $31. They are going to end up sending me a bill for thousands in a few months. So, I was told to call the exchange.

And I did. Yes, my plan was cancelled as of 12/31. No reason given, but I presume it was not cost effective like so many of them.  They wanted to put me on a cheaper plan. My problem was, I did not think my doctor would accept it - many don't - and that would mean the entire health care organization which has all my med records available for my review and which includes some specialists rather important to me, also would not be available to me. Second, I'm not taking the $31 even though - wow - because first, it would be reprehensible and second, I'm sure I will eventually pay for it. After assuring me that is all I owed per month, after one of the many holds I was put on, she came back and said - oh, maybe you are right. We have you down as having no income last year. I ask, why is that? She answers, because you haven't filed a tax return. Maybe, I say, that is because like most people, I do not file a tax return on New Years Day. We worked it out, and, of course, I have to pay hundreds of dollars a month (still good) but not remotely close to $31 a month.

And, one more thing, I almost forgot - my insurance company - they have been holding on to an over payment from 2015 they forget to tell me about. Frankly, I remember when it happened and it was their fault, but it took so long, I actually forgot about it (no surprise for me really).  That's roughly $555. Then I inquired about the $612 I sent for my premium just before they cancelled me. Oh, sorry, I was told, but since they changed your plan (without telling me), there is a new account number and we won't see your premium, even though we have it. But, we will give it back - in another 6 weeks (I'm sure meaning - if I don't forget). 

And since I wrote that last paragraph, I have yet another surprise. It turns out that not only am I going to be on the very same plan I was on that they terminated because it was supposedly cancelled (no one even understands what I mean when I tell them this at the insurance company because it makes no sense), but it turns out for the month of January, I am on a different plan altogether with a different ID no., but I have my regular doctor listed for primary care physician. BUT - they kicked him off for the new old plan in Feb., even though it is the same plan. Now, I can change it back to him, but, not until Feb., when I will have the old ID number. Get it? I don't. But, what choice do we have?

Bureaucracies have always been heavy to dance with and health care will always be expensive. And I'm sure if the Kingdom of Heaven came tomorrow there would be a software glitch - or ten, and Russia would hack it. Things do take time to work. 

The system should be changed.  I'm for the gov't assisting to standardize record keeping so we can actually have all our healthcare records permanently available. I have always been for a system that allows insurance of pre-existing conditions and like everyone I know, even the most dread haters of Obamacare, I'd like everyone who can be insured and wants to be insured - to be insured. But, the system we have doesn't work. Maybe some of those things are not affordable, period, and are a sacrifice that will have benefits in other ways.

Do I think the Republicans are going to fix it? No. But, maybe it can be improved a little. We will let go for here the whole problem with the federal government controlling healthcare because that ship has sailed. The Republicans obviously think it is a good idea too, just that they can do it better. Regular people will not believe it.

Of course, regular people will not be deciding the fate of the ACA or healthcare. It will be politicians. So . . . .