Angelina Jolie is in the headlines again. The 38-year old actress, whose last notable screen work was as the voice of “Tigress” in Kung Fu Panda, is once again a media darling. This time it isn’t her relationships, children or humanitarian efforts creating the buzz. This time she is in the spotlight, because of her decision to have a double mastectomy.
Her her choice to go public with this decision is laudable, but it is lamentable, that the actions of celebrities are often out of scale with their real significance. Case in point, Todd Essig’s article suggesting, Jolie’s decision should influence public policy on climate change. According to the writer’s tenuous point of view, Angelina is so inspiring, by following her lead, we should do all we can to prevent always lean toward prevention, even in regards to things that may not happen. Unlike Octomom, Nadia Sulliman, most of us aren’t taking cues from Jolie, if we were, there’s be an abundance of faded “Billy Bob” tattoos, and Billy Bobs-once-removed. By Essin’s logic, women should carry an umbrella, not in case of rain, but to prevent rain. Read the rest of this entry »
America has long enjoyed a love ‘em or hate ‘em relationship with the French. One would think the French and Americans would be the best of friends–after all, they gave us champagne, the beret and that awfully nice statue in the New York Harbor. However, for every American who loves the French, there is another who dislikes them. Having yet to visit the croissant capital of the world, I have no opinion, but I am a little distrustful of the latest thing out of France.
From the same country, that once tried to convince Americans we’d love the metric system, comes the work of another academic. This researcher’s findings aren’t on par with the system of measurement hailed as “a system for all people, for all times“ but like the true American I am, I am ready to reject it.
Professor and French researcher Jean-Denis Rouillon, from the Centre Hospitalier Universitaire de Besancon, has spent the last 15 years trying to determine whether or not bras are necessary, and has concluded they are not. He believes they may be detrimental not only to a women‘s appearance, but also her health. Read the rest of this entry »
It’s hard to know all the specifics of child sacrifice in Pre-Columbian America. Why were they killed? How many were there? By whom and to whom were they sacrificed? Anthropologists have found the remains of 42 children near the Great Pyramid at Tenotchitlan. National Geographic counts another 17 found near Mexico City, but the mysteries of this barbaric practice, pale in comparison to the grisly discovery of the remains of more than 45 children Philadelphia.
The stories from ancient ruins are unearthed and pieced together with educated guesses, but the evidence in this latest discovery of infanticide and child sacrifice, leaves little to the imagination. Not since the trial of Jeffrey Dahmer, has there been a case any more disturbing, than that of Philadelphia abortionist, Dr. Kermit Gosnell. It is a story of with every kind of evil…murder, greed, drugs, racism, vice, politics, sexual deviancy, and horrendous medical malpractice. Read the rest of this entry »
A cool thing I learned from my brother is how to snare a lizard and make him walk on a leash. It’s simple. Make a small leash with a slip-knot–a long piece of grass works well. Put it in front of the lizard. He walks right into it, because moving backward is unnatural to him. Voilá! A lizard controlled on a leash, for the amusement of all.
The biggest misconception about The Affordable Care Act (ACA) is that it was crafted by people who cared about healthcare. Like a prom dress on a drag queen, the ACA hides what is really underneath…MONEY. The ACA was a cunning way for government to take a bigger piece of America’s income, by promising to fix our healthcare system. Never mind, that many reasons costs are so high, are the direct result of government meddling. Despite the dubious ethics of FDA drug approvals, regulations governing what insurance we can purchase, mandates forcing employers to promote HMO’s, OR the creative accounting required by doctors and hospitals to cover the cost of treating those who are already on the pathetically underfunded government healthcare known as Medicaid, we trust them to make halthcare more affordable.
Conservative wonky-chick Ann Coulter said it this way, ” As usual, the solution to a problem created by government intervention, is more government intervention. This is like trying to sober up by having another drink.”
We are to believe the same government that has rarely been able to do anything in an expedient and cost-efficient way, can now make healthcare more efficient and affordable. We are to believe a plan which provides for 16,000 more IRS agents, but not a single doctor, will be more patient-friendly. We are supposed to believe even though two of the people closest to the President, Michelle Obama and Valerie Jarrett, were previously implicated in “patient dumping” schemes, their motives are pure. Read the rest of this entry »
Effective programs start with targets. This was certainly true of The Affordable Care Act (ACA). During the preliminary arguments for passing a universal healthcare bill, proponents reminded us of rising costs, the plight of the uninsured, and the financial toll that often accompanies serious illness.
Those who campaigned for the bill, succeeded in convincing many Americans the target was providing affordable healthcare, but the REAL targets were far more complex. Cloaked in compassion, the crisis-speak was compelling, but the facts were misleading. The number of uninsured, that was repeated over and over, was grossly inaccurate. The projections of future costs were unrealistic, and the promise of lower costs are already proving false. Read the rest of this entry »
Listening to defenders of The Affordable Care Act (The ACA, aka ObamaCare),it’s easy to believe the lynchpin issue is whether one is Pro-Life or Pro-Choice.
Those who fully understand The ACA would agree–but in a completely different way.
The big issue is NOT whether or not we should be providing contraception or abortion, but whether patients and their doctors should an active role in making choices, AND whether or not the right to live should be more important than cost-effectiveness as interpreted in Patient Care Guidelines.
The notion that opposition to The ACA is evidence of greedy indifference by those who don’t care about others is misguided. Most Americans are generous and compassionate. Without coercion, Americans willingly give to churches, charities and causes. When disasters, like the 2011 earthquake in Japan occur, Americans eagerly reach out to help. I was reminded of another American outpouring of compassion, on the anniversary of September 11th. The Wall Street Journal reported a private fund has already awarded more than 80 million dollars in scholarships to children of the victims of that terrible tragedy.
The biggest misconception about socialized medicine is that it is free and/or paid for by the government. Neither is true–unless you don’t consider the money you work for your own. The money that pays for nationalized healthcare comes from ordinary working folks, who may have trouble paying their bills, providing for their families, or saving for the kid’s college or their own retirement. Though it isn’t unreasonable for us to be expected to use some of what we make to take care of the medical needs of our families, when we share the cost of paying for others, there isn’t anyway healthcare can remain affordable.
Whether or not you consider The Affordable Care Act (ACA) to be the “socialization” of medicine, it is built on certain amount of collectivism. That’s not necessarily a bad thing. Most forms of health insurance today, utilizing health management groups–like HMOs, also rely on collectivism to keep them solvent–meaning that expenses and resources are shared.
In one way, it is not so different from joining a joining a grocery co-op. A grocery co-op requires a buy-in, but in return members get a share of whatever the co-op has to offer In a farmer’s market cooperative, members may get juicy peaches, fresh picked berries, eggplants or Brussels sprouts. The value to members is contingent on their willingness to sacrifice some choice, because offerings are limited to what’s available–whether or not it is what members would ordinarily buy.
If you don’t mind giving up some choice, cooperatives can offer great value, but Americans are used to making their own choices. Whether it be what flavor of toothpaste, what clothes, or foods we eat, free markets offer multiple choices as a way of competing. Because the ACA is designed to stifle competition, it aims too eliminate the ability of Americans (and their doctors) to make individualized healthcare choices.
In addition to the things yet to be decided by The Secretary of Health and Human Services, like what you will be required to pay, what insurers will cover, which treatments will approved, and what kinds of drugs can be prescribed, are Patient Care Guidelines–which also currently under construction. These guidelines will do to healthcare what McDonald’s has done to fast food by eliminating room for interpretation.
Neither you, nor you doctor will be able to get around the federally mandated Patient Care Guidelines. There will be no more experimental or alternative treatments–unless they are established and approved by Patient Care Guidelines. Every patient will have access only to what government has approved. There will no longer be any flexibility for doctors who want to try something different, when a patient doesn’t respond to what has already been tried. The choice to have a c-section or a vaginal birth will no longer be yours to make, because the Patient Care Guidelines will determine for you when a c-section is appropriate.
The Patient Care Guidelines will prescribe whether or not elderly patients will be treated, despite differences between health active seniors and their peers. Patient Care Guidelines will also determine “End of Life” (state-sanctioned euthanasia) guidelines like those already in use by The U.K.’s National Health Service. Being “fully-covered” will provide a false sense of security, until America’s collective consciousness, comes to terms with the way in which Patient Care Guidelines, assign a price tag to life.
Patient Care Guidelines are necessary to control costs, and will be used in conjunction with another cost-controlling mechanism–The Independent Payment Advisory Boards (IPABs). In our current insurance-based system, insurers routinely deny costly treatments, but patients still have the right to appeal those decisions. The Federal Government will not offer the same flexibility.
These board will be comprised of 15 presidential appointees, who are given the authority to propose cuts to Medicare (without congressional approval) whenever Medicare spending exceeds government targets. (This in in direct contrast to the arguments that the ACA is good for seniors, as there is no way to know what kinds of cuts will be necessary in the future.) Though this provision is written in such a way as to make “rationing” care illegal, the Patient Care Guidelines provide a legal (if underhanded) way of doing exactly that.
So, like a co-op member who becomes dissatisfied after getting too many Brussels sprouts, and not enough berries, it may take a few years before Americans become disillusioned by the implications of The Great American Healthcare Cooperative. In the meantime, American goodwill will be tested, as we collectively absorb the costs of paying for things we aren’t getting or don’t want.
It is unlikely that paying for contraceptives and abortions would ever have enough financial impact, to have justified making it a recurrent theme at the recent Democratic convention, but it won’t be long before ordinary Americans begin realizing the impact of federal mandates that dictate not only what isn’t covered, but what MUST be. Already, there has been an outcry from those whose religious beliefs are compromised by being required to share costs for things the oppose. Catholics and other pro-life believers are justified in feeling this is an unfair impingement on their religious beliefs, if for no other reason than the waivers given to Scientologists and Muslims, and The Church of Big Labor on the basis of theirs.
However, even the non-religious may take issue with the ACA, upon realizing they have to buy into a plan that pays for gender-reassignment surgeries, while putting limits on breast, and other, reconstructive surgeries. So, thought you may not require or desire gender reassignment surgery, and may not be opposed to anyone else having one, when you are denied a surgery you do require, you may begin to feel the ill-fit of of one-size-fits-all coverage. Americans must now decide whether the illusory security of “full coverage” under nationalized healthcare, is of more value than the ability to make their own choices regarding life and death. In the meantime, there is an upside…Americans won’t be forced to share the medical costs for Scientologists like Tom Cruise, Greta Van Susteren or John Travolta.
Deb’s Note: This is the fifth post devoted to explaining the Affordable Care Act–aka ObamaCare. I have chosen to write about this subject, because I believe women need to know how it will affect their families and/or loved ones. It is always my intention to uplift and empower women with what I write, but last week’s post re: the ACA was so depressing, even I was in a funk–which is why last week’s post ended up in the trash bin. Just a couple more posts to wrap this subject, then I hope to move on to less-serious subjects.
Whether you are bungee jumping, or buying a home, before you are allowed to take the plunge, you are required to sign papers acknowledging you understand the terms. Agreeing to a deal with another party, without having any idea of the risks or conditions, would be like purchasing expensive concert tickets, without knowing if the music featured would be panpipes or gangsta rap.
Even if we don’t like laws passed by our government, as Americans we have the right to know the implications of those laws. Generally, they are not beyond our comprehension, because the conditions and enforcement are usually written into the language, when they are passed by our legislative bodies. This is not the case with the newly adopted legislation of the Affordable Care Act (ACA) which will change everything about American healthcare.
Nancy Pelosi immortalized herself, when she said, we had to pass the bill to find out what was in it. This was perhaps the most misleading political understatement in American history. Even now that it’s passed, it is STILL impossible to know what is in it, because it was purposely written with vague to-be-determined-later provisions. What Ms. Pelosi should have said, is that we will have to LIVE this bill to understand what was in it.
The length of the bill was astounding when it was passed, but nothing compared to what it will be in the future. Like an evil creature in a Sci-Fi flick, it isn’t finished growing. It will continue to grow and morph into something most have yet to imagine.
Why? Because it was passed with rules to be decided later.
The bill that was promoted as the answer to our healthcare woes, gives authority over your body to The Secretary, because The Secretary will determine how it will be enacted and enforced. In fact, the language of the bill mentions the power of “The Secretary” over 3,000 times. The Secretary would be The Secretary of Health and Human Services–a presidential appointee who need not have medical experience.
Certainly, someone has to decide what kinds of treatments will be provided, but say goodbye to the days when your medical decisions were made by you and your doctor. It will now be up to The Secretary to determine what drugs will be paid for, which treatments are cost-effective, and whose treatments will be denied.
We were told we would no longer be denied care. We we will no longer have to worry about not being able to afford treatment, having coverage denied because of pre-existing conditions, or the lifetime caps that insurers impose. We were told if we liked our insurance, or our doctor we could keep them.
All of those things ARE true. Insurers will no longer be able to turn down those with pre-existing conditions, impose lifetime caps on benefits, and we will no longer have to worry about the cost of treatments. Like many of the statements made to convince us of the virtues of this plan, these statements are technically true, but deliberately misleading.
Perhaps,you’ve seen the compelling stories of those sharing how ACA saved a life. I saw one the other night. A woman shared the story of how her son, Travis Turner had medical expenses exceeding $1million dollars in his first year of life, causing them to exceed their insurer‘s lifetime cap. He is now 8 years old, and thanks to “Obamacare”, he is insured again. The story was poignant to be sure, but the hopeful picture it paints is misleading.
Like Ms. Turner, many optimistically attribute improvements in their healthcare to the ACA, but others are aware of how their healthcare is already being adversely affected as changes are implemented. On either side of the issue, many are confused about how much of this bill has been implemented. All the provisions of the bill will not be enacted until 2018. By then, The Secretary may not even have finished defining those yet-to-be-determined provisions.
However, there are things we know.
- We were told if we liked our doctor OR our insurance we could keep them, but The Secretary will be able to dictate how your physician can treat you, and what your insurance can cover.
- The Secretary will determine whether or not your insurance meets the regulations as a “qualified” plan. If The Secretary determines it doesn’t, you WILL be forced to choose another plan.
- Your plan will only be allowed to pay doctors approved by The Secretary.
- That provision above shouldn’t matter much. With The Secretary determining how even the privately-insured can be treated, there won’t be much difference between doctors.
- You will no longer enjoy doctor/patient confidentiality, as EVERY detail of your health will now become part of a government database on each citizen. EVERY detail. (ACA provisions override that pesky pre-existing condition known as privacy law.)
- The cost of your plan will change as The Secretary determines what qualified plans will cover, and what they will cost.
Costs will rise, ,as the burden of providing coverage to all, increases costs for individuals and families.
- Though claims that ACA would result in rationing of care were denied by its proponents, the bill is full of Patient Care guidelines (some still under construction) as to who will get care–and what care they can get.
- Additionally many of the provisions in the plan are exempted from judicial review. Translation: If your care sucks, you can’t seek legal recourse.
Those between the ages of 15 and 40 are to be given priority over children and the elderly. This might come as a surprise to aging baby boomers, their children and any parent of a child needing life-saving treatments. Those in their “golden years” will find less care available to them than those who fall between these golden ages–the period of life when most of us are at peak health and fitness.
Perhaps the mother and child featured in this ad will be lucky. Travis will be turning 15 around the time the ACA is fully implemented. If he stays healthy, he can expect at least 25 years more of priority healthcare–unless The Secretary determines treating a child with a history of liver cancer to be less than cost-effective. His mother, on the other hand, appears to be around 30, which means she can only look forward to about ten years in that preferred patient group.
As she moves closer to Medicare age, I hope she realizes, ACA allows for changes to Medicare without further approval from Congress. She looked like she might be a little overweight–God help her is she develops diabetes, because priority for scarce treatments like kidney transplants and dialysis will be given to those in the 15-40 age group. Let’s hope she doesn’t develop breast cancer, because she won’t be eligible for regular mammograms until after she turns 50. If she should develop heart disease, she may find The Secretary has determined her too old to warrant the cost of a pacemaker, or open-heart surgery.
It is true, we will no longer have worry about the costs of treatments, being being denied coverage because of pre-existing conditions, or not being able to afford our medical expenses. This is a new era, in which our only concern will be getting good medical care.
Deb’s Note: This is the fourth post devoted to explaining the Affordable Care Act–aka ObamaCare. I have chosen to write about this subject because I believe women need to know how it will affect their families and/or loved ones. The subject is extensive, but I hope to wrap it up in a couple(?) more posts.
Katy Perry says we need to get the money out of politics, in a recent Rolling Stone interview, she was quoted as saying, “it feels like the thing running our country is a bank, money…and the fact that America does n‘t have free healthcare drives me f**king absolutely crazy, and is so wrong“.
Poor Katy, like many Americans she does n‘t understand how money fuels politics, or that there is NO such thing as FREE healthcare.
It is the politics of money, not health, that impelled our government to pass The Affordable Healthcare Act (ACA). The ACA has been represented as a measure to provide affordable, accessible healthcare to every American, but it isn’t free. It isn’t free for the government, which means it won’t be free to the taxpayers. Sadly, it isn’t even without costs to the poor.
The one part of ACA most Americans are most aware of is the “individual mandate”, which requires every American to purchase healthcare, or pay a fine. Simply stated, the ACA will guarantee everyone in America access to healthcare, by requiring us to buy it. If you are required to buy it, it isn’t free. Summing up the individual mandate–Americans are cordially invited to a “Free Lunch”, for which they will pick up the tab.
Of course, there are waivers for the poor, which will grant them access to the same kind of healthcare they had under Medicaid–underfunded, limited access, and minimal care. There are also waivers for many rich, like labor union leaders. Since those with lower incomes will largely be exempted from the individual mandate, many see this plan as a necessary way to get the rich to pay their fair share, but unfortunately, it is middle-class working folk who will be most adversely affected.
In grand irony, employers, who have offered health benefits, willingly and without government coercion, will now have an incentive not to. Employers with 25 or more employees, will be required to pay for employee health plans, or pay a fine. Unfortunately, because the fines are much less, than the cost to pay for employee plans, there is a built-in incentive to give the money previously used to fund benefits for employees, to the government. As the cost to insure employees rises, jobs will be lost, because of increasing costs to employers.
Under our current system, a single individual can be insured for under $5000, but a family’s costs can easily exceed $10,000, but don’t pencil that into your budget just yet. The Congressional Budget Office (CBO), independent economists, and private research firms have already projected how this plan will increase those costs. The consensus among number-crunchers, is the ACA will cost families more–especially, as the cost to insure their families rises. This will be a startling eye-opener to those who have don’t have any idea what their employee-provided plans cost.
The individual mandate is unique, because it is the first time in the history of this country,our government has required us to buy something. The closest thing in our country to the individual mandate, is the state requirement for drivers to have auto insurance. Taking responsibility for driving is something most would agree is necessary, likewise, it doesn’t seem unreasonable to ask citizens to take some responsibility for their health or healthcare–but there are a couple of differences. First, with auto insurance, the free market allows insurers to compete for our business–more importantly, we are given choices as to what kind of coverage we can afford. Secondly, though driving is optional, wellness shouldn’t be.
Maybe that freedom isn’t important to you, but if the government controls what you will buy, you can be reasonably sure “affordability” will be short-lived. In fact, government regulations are a primary reason our existing health insurance has become so expensive. Not only, does the government regulate what must be covered, but also which kinds of plans employers must offer.
Nevertheless, let us assume the number-crunchers are wrong, and the the majority of Americans merge seamlessly into our new healthcare system. This plan puts 1/6th of our economy under federal control, and though the bill makes no provisions to add more doctors, it does provide for new governing agencies and 16,500 IRS jobs to police the not-a-tax mandate. Though President Obama insisted the individual mandate wasn’t a tax, The Supreme Court has ruled it is, and the government will enforce it as such. If you love the IRS, this plan is for you!
The United States government has yet to operate anything without waste and inefficiency, but this could be a first. Certainly their effort to operate “mean and lean” is evidenced by the provision which will cap doctor’s salaries. This provision to insure doctors can’t get rich, will also provide a disincentive to those who would become doctors. Economists are already predicting a “brain-drain” as the incentive to study medicine is diminished.
The idea of capping doctors salaries, appeals to those who misguidedly believe doctors make too much, but what is greatly misunderstood, is how fees charged by doctors are more the result of government meddling, than doctor greed. Not only that, but when free-market forces determine salaries, money is a great motivator to be the best there is. Money is the reason this country has enjoyed better medical technology and pharmaceuticals, than any other country in the world. Government-set salaries will do little to motivate care-givers to do more than is required.
We don’t think of hospitals as businesses, or doctors as entrepreneurs, but they operate under the same rules of profit and loss as any other business–except for one small thing. Most of our medical charges are not paid by us, they are paid by a third-party, the insurer. They are expected to provide the same services to those who cannot pay, as to those who can. One can imagine what would happen if Prada or Louis Vuitton were made to sell everything they make according to what customers could pay–there would be no incentive for them to make the kinds of things, for which, customers willingly pay more. It is the free market which allows Nordstrom and Target to both sell jeans, but give you the freedom to decide which you will purchase. Absent from our current third-payer system and the ACA are free market forces.
The third-party payer takes away consumer power, by artificially removing market forces, and causes healthcare to operate under regulations unlike those governing anything else we buy. Consumers have little power in the healthcare market, because we are customers of our insurers, not our doctors. With employers picking up the tab for our insurance, we have little control over what we get for the money, and little freedom to shop for what plans best match to our needs. The current third-party-payer system has made it necessary, for doctors and hospitals to inflate their charges to cover losses caused by the uninsured and those patients whose government-subsidized healthcare doesn’t cover their costs.
The third-party system isn’t the best, but the single payer system compounds the problems. Not only we will we now share the cost of insuring everyone else, but we will be forced to absorb the cost of providing everyone the SAME benefits. Our costs will no longer be based on our own lifestyle choices, or the pool (community rating) of those we work with, but will now be expanded to include those whose lifestyle choices put the greatest burden on our healthcare system.
The net effect, is that insurers will not be able to afford to do business as they have in the past. Individuals and families will find the cost of insurance skyrocketing, in response to the changes. Ordinary families, who are no longer insured through their employer, may not even be able to afford to comply with the individual mandate, but will still incur fines.
The individual mandate isn’t even the tip of the iceberg. The lack of accessibility and the diminished affordability of this plan, will not be fully realized until we are well-into the next presidency. By then, people will begin to see whether the ACA is a pancea, or a bitter pill to swallow.
Deb’s Note: This is the third post devoted to explaining the Affordable Care Act–aka ObamaCare. I have chosen to write about this subject because I believe women need to know how it will affect their families and/or loved ones. The subject is extensive, but I hope to wrap it up in a few(?) more posts.
Health insurers make money, in much the same way bookies do. It is an odds-makers’ game requiring more players than pay-outs to sustain it. Those who run the game, bet on the odds of there being more healthy, than sick. The thought of insurers profiting offends many, but insurers have to make money to be solvent.
Forget the 1%…in America, the 99% live more affluent lives than most of the world. Despite our prosperity, we are frightened or frustrated by the cost of medical care. American healthcare is costly, but the notion that costs have spiraled out of control is largely the result of how removed we’ve become from actual real costs.
A hundred years ago, healthcare was costly. Then, it was because the nation was poor. Now it is because our medical care is outstanding. In the era when doctors made house calls, they would often be paid in whatever currency their patients had, whether it be a few dollars, or a basket of eggs, but because we can’t always anticipate our medical expenses, the cost of healthcare is one item that exists outside our household budgets.
Paying the doctor in eggs was harder when the average hourly wage a little more than a quarter, but even in our era of unprecedented prosperity, healthcare costs can be burdensome. We carry phones that cost hundreds, have household electronics that cost thousands, and pay more for a night of entertainment than we are willing to pay for an office visit. Grudgingly, we cough up fees for the one thing more valuable than any other–our health.
Until we face an illness or injury, most of us don’t even have a realistic idea of medical costs. Upon seeing a bill for a twenty-minute visit with a doctor, we may wrongly assume the doctor is over-paid, but to determine his costs, we would have to factor in all the others things we are indirectly paying for like years of expensive training, operating costs like rent, lights, and equipment, or high premiums for malpractice insurance. Add to those the expense of the support staff required in a small medical office to schedule appointments, assist physicians, process claims, handle the record-keeping, or do the accounting.
We’ve come a long way from the time when a doctor’s treatments were limited to what would fit in a satchel, but to understand today’s costs, it’s helpful to understand the evolution of American healthcare. Only a century ago, the concept of health insurance was new. During WWII, employers were under wage and price controls. To attract the best employees, companies began to offer health benefits in lieu of higher wages. Those early plans paid most of a patient’s medical bills, but patients shared some portion, making it necessary even for those with insurance to be conservative about seeking medical care. Traditional insurance gave consumers an awareness of “real” costs.
In the ‘60s and ‘70s, government intervention again changed healthcare, first with the creation of Medicare and Medicaid, later when President Nixon enacted legislation to popularize Health Maintenance Organizations (HMOs) The first HMOs followed the Kaiser Permanente model, which had reduced costs by limiting and standardizing care. The upside of the HMO’s was coverage of preventative services, like mammograms or immunizations. These plans offered more for less, making consumers more inclined to see doctors, but this factor and the number of required to administer HMO’s, began to decrease their profitiblity of the HMOs.
Real costs were largely replaced by co-pays, and a lessening of patient choice. Physicians were offered incentives for treating patients conservatively, as those who managed these plans tried to spread resources among many members with varying medical needs. As the doctors become more accountable to managers than patients, getting care became more complicated. Managed care was really about managed costs.
Medicaid and Medicare gave more individuals access to healthcare, by placing their beneficiaries in HMOs or the same pools as the privately insured. This was a good solution, until the low fees paid to providers, failed to cover the costs of the services provided. The difference between fees and costs, made it necessary to shift those costs to other patients–artificially inflating costs.
Many favored a government-run single-payer system. If you are a parent, it is likely your house operates with a single-payer system. At least one adult makes money, which is then used to fund all the expenses of the household. Because the amount of money is limited, someone has to make the decisions about where the money will be spent. Everyone in the home has a want-list, but there simply isn’t enough money to for everyone to get everything on their list. The person(s) in charge of the money, have to make the best decisions they can as to what is practical or impractical.
Children may not understand all the details of household finances, but they come to understand they can’t have everything they want. Parents aren’t “rationing” what their kids get, but out of necessity, parents make decisions to assure there is enough money for things like food & shelter. Whether it be the one in your house, or that of nationalized healthcare, every single-payer system operates within limits. This balancing act is necessary to sustain the system. The Affordable Care Act, sets up an extensive set of rules which attempt to establish how this will be done. My next post will examine some of those provisions.
Deb’s Note: This is the second post devoted to explaining the Affordable Care Act–aka ObamaCare. I have chosen to write about this subject because I believe women need to know how it will affect their families and/or loved ones. The subject is extensive, but I hope to wrap it up in a few(?) more posts.
My “light bulb moment” began with a Band-aid. I wouldn’t have sought treatment for the wound, but Beloved Soul Mate insisted I get a tetanus shot. The adhesive bandage used to cover an inconsequential injury, triggered a mental disruption that lingers, almost two decades later.
Back then, I had old-school insurance. Not an HMO, not a PPO, just an indemnity policy. An indemnity policy is a contractual agreement between an insurer and the insured, as to whom will pay for what. On the itemized invoice, a generic type of Band-Aid (which was called a surgical dressing) cost $66. The wound healed fine, but long after, I was bothered by how and why the charge for something with a retail value of about .11, cost six-hundred times as much.
Perhaps my insurer and I were subsidizing the cost of treating deadbeats, illegal aliens, or those who couldn’t afford treatment. Maybe the inflated prices were helping pay for expensive treatments, or cover costs associated with malpractice. Whatever the reality, that “surgical dressing” seemed to be “window-dressing” on a larger problem.
Not long after, Hillary Clinton began doing her best to convince America to adopt a national healthcare plan. After being charged so much for so little, I was interested, but skeptical. It was clear costs no longer reflected the real cost of services.
It was easy to see symptoms of distress in our medical system, but there was no easy remedy. I’d heard the rhetoric about, rich doctors, greedy insurers, profiteering lawyers, and money-grabbing pharmaceutical companies. It seemed greed was at the root, but nobody was talking about self-interested or freeloading consumers–even though it was well-know patients would clog emergency rooms for non-emergencies, like colds to avoid paying doctors. It seemed even those with insurance wanted everything for nothing.
The huge disparity between what consumers paid and the costs of what they received could not be ignored. With the best treatments, innovative technologies and the ongoing development of life-changing drugs, medicine in America was then and is now, generally the best in the world–except for one glaring thing. Some were receiving services for less than what it cost the providers, others were paying more than seemed reasonable for services received. High costs and the plight of the uninsured seemed to necessitate an overhaul, but with government-intervention, a decline in the quality of care seemed inevitable.
No matter what anyone paid, one thing remained the same. The value of health or life, could not be measured in dollars and cents. Whether it was a premature birth, a child with cancer, or an aging parent, when the patient was someone we cared about, we wanted the best care money could buy–even if it meant risking financial ruin.
That Band-Aid, was overpriced, but a bargain, because it launched my education into healthcare. Not an easy education, but an ongoing quest to understand the real costs of healthcare. Healthcare in America is good, but there isn’t a Band-Aid big enough to fix the problems. After years, not months, of dedicated reading and research, I still feel barely qualified to write about it. The problems affecting our healthcare system are far-reaching and complex.
Every aspect of our medical system has been affected by the necessity of cost-shifting, which is why some form of nationalized healthcare seems to be the necessary solution. Unfortunately for all, the issue has become money, not health. Giving the government the authority to make sure everyone gets care seems like a great idea, but it’s problematic. The next phase in American healthcare will be redefined by costs, not care.
There isn’t anyone who can fully know or understand the implications of the Affordable Care Act, (ACA). Not only is the new law thousands of pages, but it leaves many provisions undefined. I‘ll do my best to hit the major points, as they have been defined–with my only intention being to represent the facts fairly. Because of my sincere desire to write without partisan bias, I prefer to call the bill that has been passed, by its proper name, The Affordable Care Act (ACA) instead of its better-known name “Obama-Care.”
Over the next couple weeks, I hope to shed some light, on what can be reasonably expected under The Affordable Care Act. My intent is not to politicize this blog, but to illuminate issues affecting this audience. The issue is healthcare, not politics. Everyone needs to be aware of changes that will affect our healthcare system, but the issue is of particular importance to women, since we are often the primary caregivers for ill loved ones. The facts are sobering. If you value your health or the health of those around you, you cannot afford not to know what to expect under “affordable” healthcare.