U.S. must come to grips with health care costs, basic care for uninsured

 

2-3-2021

 

There are 28.9 million Americans who have no medical insurance—and that number is rising. With today’s enormous medical costs, major illnesses and accidents can wipe out a family financially, creating poverty that can be impossible to overcome. How can our health care system provide high quality medical care to Americans, while making costs affordable?  And what role should government play in making this possible?”

Steve Clark

Health care and how Americans pay for it remains one of the nation’s most controversial topics. Last week President Biden rescinded and executive order by President Trump that, among other things, canceled the penalty for failing to sign up for the Affordable Care ct (ACA), better known as Obamacare.

Eventually, the Biden action could mean people who are uninsured and who don’t participate in Obamacare will get a tax penalty. But it appears it will take some time before the mandate to have coverage can be restored.

The Biden action renewed the controversy over health care. Most Americans are covered by Medicare, private employer provided insurance, Medicaid, veterans benefits, etc. At issue is the availability of insurance for a small segment, approximately 11 percent  of the population, and their ability to pay for it.

Universal emergency health care already exists by statute in America. No person, citizen or non-citizen, can be denied emergency medical care at a hospital if they present themselves. The question becomes, what do we do about the costs for the 11 percent who have no insurance coverage.

The ACA is a coin with two sides. On the positive side is the ban on disqualification of prospective policy holders for  preexisting conditions as well as the ability to retain college-age children on the parent’s policy.

On the negative side is vastly increased premium costs for everyone, not just the 11 percent; outrageous deductibles that made an Obama care polity tantamount to not having insurance for most families; and being limited to plans participating in Obamacare and consequently, not always being able to see the doctor of one’s choice.

The questions for us today is: How do we keep the positives, protect the unprotected population and make government’s expanded role in health care more palatable in a population that mostly eschews government intrusion and resents government mandates on personal behavior. I have some ideas that I’ll discuss in my follow-up. Over to you, Alison.

 

Alison Anderson

You’re right Steve—only about 11% of  nonelderly Americans are uninsured. But remember, many more are now unemployed due to COVID. These people increase our medical costs because they end up receiving their health care in ERs, and they don’t see a family doctor who knows them and can help with diet, exercise and general well-being. They’re at huge risk financially.

Here in the United States, our medical care system is built on a business model, not on a care model. We have a fee-based system where services and medicines are provided for those who can pay for them. If we can afford better treatments or more expensive medicines, we may receive better care than someone less able to pay.

In other affluent countries, access to health care is considered a right. Their systems provide basic care that results in better outcomes for the rich, poor and middle class. Although Americans have great doctors, excellent technology and equipment, we have gradually slipped behind other industrial countries, especially in health care provided for the poor.

We need a compromise program—one that allows those who can afford premium health care to choose it, yet provides a safety net for those who are uninsured. President Biden proposes such a system—one that gives insurance for basic care to all Americans, but allows those who prefer to add or substitute their own medical care provider to do so. Yes, this will cost money, but not more than we now pay to compensate for the millions that hospitals write off every year for crisis care. If the Affordable Care Act is improved and strengthened, more Americans will have some protection, and that’s good for all of us.

 

Steve’s second response:

I agree that the only way forward is legitimate compromise on both sides. I wish that President Obama had considered that when he rammed through the ACA without Republican buy-in, leaving us in the current mess. President Biden appears to be on the same path.

In my opinion, we should retain the positives from the ACA and start all over again on the rest.

The automobile insurance industry already gives us a model for dealing with the small segment of population who has trouble getting insurance. Those who can’t get insurance in the regular marketplace have access to a pool that all insurance companies are required to participate in that provides coverage without affecting the choices or coverage options of the rest of us.

This means that we can buy insurance with low or high deductibles, various coverage limits and other features without restriction or without penalty from the government.

Such a health care pool would not be without cost to the insured. Everyone still has to pay premiums. Those whose incomes fall below certain limit may need to be supplemented to some degree. Non-citizens without permanent residence status should not qualify for any subsidy.

A citizen should not be mandated to participate. Like automotive programs, a citizen should be able to declare himself/herself “self-insured” and be exempt from all penalties and mandates, and, of course, bear full liability for their own consequences.

What must be eliminated in any new program are ridiculously high deductibles that are more like having no insurance at all, restrictions on our choice of health care providers, and use of the IRS as the enforcement agency.

 

Alison’s second response:

Steve, be careful about condemning President Obama for “ramming through” the ACA. He and the Democrats in Congress made innumerable compromises to accommodate Republican demands before it finally passed in 2010, and Republicans still voted against it, as they did many of his initiatives.

Many of the flaws in the plan are weaknesses that came from these compromises—and these were acknowledged from the moment the ACA became law. In spite of a full-fledged attack on the ACA by the Trump administration and the Republican Senate, it is still with us, and no plan has emerged to replace it during the last four years.

So improving it is a must. Higher enrollment will drive deductibles down, and we’ll see that happen this spring as part of the Biden plan.

You also object to mandatory participation—I understand this, and I like to see the doctor I know when I go for my check-up. However, wouldn’t it be great to be able to be treated reasonably, on the weekend, without driving an hour to the nearest instant-care clinic for a strep throat for less than $1,000, which was the cost of a recent ER visit for me?

And imagine access to a clinic where anyone could drop in to get prenatal or pediatric care, treatment for a rash, or a few stitches at a reasonable cost!  If our government could provide these sorts of services in clinics similar to those being created for employees of Apple, Google and Amazon, I believe we’d all take advantage of them and be grateful.

We’d likely carry additional insurance so we had more choices in case of serious illness, but honestly, I wouldn’t resent a mandatory enrollment if I didn’t have to wait six months for a dermatology appointment. These are the kinds of services that might be possible if our public health system was more robust.