Monday, March 13, 2017

Healthcare in America....where are we headed?

Yesterday a friend of mine, who is in the healthcare field, asked on her Facebook page what should be done regarding the "repeal / replace" controversy now raging.  She and her other healthcare professional friends agreed some form of coverage for everyone is absolutely necessary, while her more "conservative" friends said "no way". 

First, a personal disclaimer.  I'm covered by Medicare, which has worked great for me, and my wife, who is now once again a full-time college student, has a group plan offered through her university.  And after her college days, as a last resort, she is a disabled veteran and has VA care available to her.  In short, I have nothing personally to gain or lose in this debate.

The argument I heard from the conservative "Tea Party-types" was that they resented being told they MUST buy insurance, and would be perfectly happy if it would just go back like it was pre-ACA / Obamacare.  My strong suspicion is that they have secure (for now) jobs and enjoy employer-provided insurance, or are older and are covered by Medicare.  Both see ACA as just a giant wealth transfer from them, the relatively affluent, to the poor.  There's no upside to them if there is a replacement plan.  They would prefer repeal, period.

Those in the healthcare field almost universally say they see the desperation every day on the faces of people who can't afford insurance or the ER medical care they've been billed for and are absolutely begging for their charges to be forgiven by the hospitals and doctors.

My observation is this:  The Tea Party-types know in general terms that poor people can't afford healthcare for themselves or their families, but they don't actually know any of them.  They just can't relate.  I can.  During my 40+ year career in homebuilding I saw on a daily basis plumbers, electricians, painters, roofers, etc who I'm certain didn't have health insurance.  

They may work 40 hours one week, and just 30 the next.  If the economy tanks, they may have no work for weeks at a time.  They're always on the brink of desperation.  They work hard....they certainly aren't slackers. They don't get a yearly two-week paid vacation, or have a 401K, or health insurance.  That's just the nature of the construction industry.  Are we just gonna kick people like them to the curb?

In the old days you worked 40 years for your company and retired with a gold watch.  Today if you have seniority, which probably came with yearly pay raises for decades, you're now at the TOP of the pink-slip list.  You're good as gone, to be replaced by a 25-year-old with a MBA who will work for 40% less than you're making.  And if you're 58 and find yourself with more and more ailments, and you're suddenly unemployed, how are you going to afford health insurance?  Who wants to insure you?

I know plenty of people who are / have been in that very position.  A secure job today is no guarantee of a secure job tomorrowRemember that!

"Oh", the Tea Party-types say, "they won't be able to deny you because of a pre-existing condition."  Isn't this a classic example of having your cake and eating it too?  They abhor the ACA, yet want to cherry pick the parts they want to keep....without paying for it.   Sorry, but life doesn't work like that.  "You'll still get a [smaller] subsidy" they say.  Again, they're UNEMPLOYED!  They have no income!  A [smaller] subsidy is worthless to's like being promised a BIG piece of NO pie.

I laugh incredulously when they say they'll expand Health Savings Accounts that people can use to pay for their health insurance and deductibles. They just don't get it!  Lower income people don't have the luxury of putting a few hundred dollars a month into a HSA.  They're living hand-to-mouth as it is.  It's like Marie Antoinette telling her hungry French subjects "Let them eat cake."

The Tea Party-types ask how fair is it for them to pay into an insurance scheme that benefits someone else?  So let me ask, why should residents in West Texas pay higher homeowner insurance rates to make up for their fellow-Texans who have suffered hurricane damage on the Gulf Coast?  Why should I pay for an interstate highway in Ohio when I've never even been to Ohio?  Why should I pay school taxes now that my youngest daughter is 35 years old?  Because it's for the public good, that's why. 

If we average the cost of healthcare across all age groups around the country, the young will indeed pay more now than they could have before the ACA, but they'll make it up later in life when they'll need healthcare and get a sweet price break.  That's how a "risk pool" (insurance) works, and there's nothing more free-market than insurance.  

Yes, I hear those who point out that insurance is optional, but not buying in means no benefits.  Are they going to be the gatekeeper at the hospital door that turns away the hysterical mother with no insurance cradling her deathly ill child?  And if the mandate stays that requires hospitals to care for anyone who walks in, whether they can pay or not, how much longer will it be before marginally funded hospitals start closing? 

I don't know how this will ultimately play out, but times have changed, and we must change, too.  We need to find a way to provide healthcare for all our citizens.  They can't give healthcare away, I understand, but anointing some to enjoy the American "good life" while condemning others to always being on the outside looking in is not what America should be about.  America should not have a caste system.

Not everyone can have an enviable IQ, be well educated, have a secure, high-paying job with benefits, and just skip merrily through life.  If they could, who would be left to change our oil, or build our houses, or maintain our sewer systems?  *any volunteers?* 

It won't be easy, and it won't be cheap, but we will be a stronger, more internationally competitive country if we're healthy and working smart.  We MUST find a way to care for our own. 



  1. We only need look north of our border, or across the pond to find a good method. We are the only 'industrialized' first-world company without national medical insurance.
    Good post.

  2. There is no real good answer. It is going to be expensive because healthcare does so much more these days. My my father and grandparents paid very little for healthcare, but they died before they saw 65...two did not make it to that's expensive. I'm thinking national insurance for major medical costs, and private insurance for lesser coverage, priced and having deductibles by personal choice, but I have no idea. What we have today is not very good and seems on the verge of collapse, what we had before we have what we have today was also pretty bad. Hospitals picking up the tab for extra expensive emergency care and passing it on as best as possible to the insured.

  3. Engaging post. Historically, Republicans are acting true to form. They were against Social Security, Medicare, Medicaid and Food Stamps. They consider these entitlement programs and want to eliminate them. Oddly, Trump supporters enjoy these benefits more than nearly everyone else.

  4. "I laugh incredulously when they say they'll expand Health Savings Accounts that people can use to pay for their health insurance and deductibles. They just don't get it! Lower income people don't have the luxury of putting a few hundred dollars a month into a HSA. They're living hand-to-mouth as it is. It's like Marie Antoinette telling her hungry French subjects "Let them eat cake.""

    So very true. It's always sadly funny to me that the people whining about having to buy health insurance never complain about being forced to have car insurance. When I mentioned this once, someone said, "Well what if I get into a car accident?" What, you're never going to get sick? And when you look at the price of hospital services, one surgery can pretty much buy you a new car.

  5. I saw the post you are talking about, and I almost responded to one early commenter who said there is nothing in the constitution that gave government the right to force people to buy something they didn't want.

    Well, government is forcing us to pay taxes for roads we may or may not use. Some people don't pay taxes at all, yet they still enjoy the freedom that "doesn't come free" provided by our very expensive military, just like those people who do pay taxes. And people who have no kids in school pay school taxes, imagine that. We should look at health insurance premiums as just another tax...a tax that will strengthen our nation, just like good infrastructure and a capable military force does.

    Funny, I've never heard many people complain about mortgage companies forcing you to buy homeowner's insurance...

    1. And my reply to Michael's question of what section in the Constitution can be used to justify mandatory participation in a healthcare program, was whatever section that passed judicial review and allowed mandatory Social Security and Medicare.

  6. When you say "we must find a way to care for our own" you are absolutely right. Thank you for this insightful post.

    With one exception.

    Marie Antoinette never said "let them eat cake". If anyone ever said it, it was someone else. You can Google it. :)

    1. Did I say "cake"? Oops, sorry. I meant ice cream. *wink*

  7. Good post. My 2 cents...get rid of private health insurance, get rid of 'pay master ' lists. Then have Gov pay doctors and hospitals directly. The money would come from taxes that replace money paid to insurance. It would be kinda like a giant Medicare system. No one is refused reasonable health care. Just a foolish dream. My insurance and hospital I used on 7 Aug are still haggling over what money will change hands, $170K to $400K and getting closer......Not a way to run a healthcare system.

  8. A system is already in place. It is called Medicare. Medicare for everyone. The insurance companies lobby has too much of a grip on Congress to be excluded. With Medicare for everyone, the insurance companies still get their pound of flesh with the current supplemental plans and the insured is able to pick how much they want to spend for coverage over Medicare with the ten different medigap plans. If you have a social security account you would be covered under Medicare. Follow it up with realistic price controls on prescription drugs.

  9. "Because it's for the public good, that's why..." brought a tear to my eye - really! That's my whole philosophy for politics.