History is the autobiography of a madman – Alexander Herzen
So after a long hiatus I’ve decided to reboot this and crank out some material.
Last week. After 7 years and wringing their hands the Republicans who control the house, the senate, and the White House shockingly failed to repeal The Affordable Care Act (Obamacare). While the ACA is a mixed bag, this is undoubtedly a good thing since they weren’t really working on expanding healthcare, or even access to it, but rather take it away from a reported 24 million people. So while, we knew this was coming, I think we’ve reached a watershed moment as a country in the direction of how our healthcare will be shaped in the future. But before we do that, I think it’s important to take a quick look of where healthcare was, where is currently, is and then where it could be.
Where it was: Health insurance in America started out as any insurance industry. At the turn of the 20th century hospitals started accepting “pre paying” for your healthcare instead of paying when you came. Soon it became a corporate interest and Blue Cross was born in the 1930’s. From there you would buy a plan that you felt you needed and were covered accordingly. It also became a fringe benefit in some industries But as health insurance practices became more intricate and as the population of the country grew at a disproportionate rate, health insurance companies always wanted to make sure they were in the black, they are a business after all. Taking on sick and old people doesn’t help them make a profit. So fine print was added, changes to that fine print were mailed, (usually to the detriment of the consumer), and people were denied treatment for all sorts of reasons, with “preexisting conditions” at the top of the list.
Examples of the changes in conditions would go something like “Dear ________ please use this text (paragraphs of confusing legalese) to replace Section III part B header E of your health care plan.” Now assuming you had a copy of it on hand and you could speak as a lawyer maybe you could. But these messages were common and were usually just masks to say something like “Your health care cap is now a lifetime cap of $5 million instead of a yearly cap of $250,000. Which may be okay if you’re healthy but if you have cancer and need chemo treatment, or a heart attack that will eat up that cap fast and then how will you get coverage?
Examples of preexisting conditions could be any excuse to deny you coverage. Did your dad smoke inside while you were a kid and now you developed lung cancer 40 years later, well…maybe that cancer was a preexisting condition so no coverage for you. Did you not get diagnosed at an “approved clinic” that that insurance company likes? No coverage for your ailment. Did you have acne treatment as a teen, well there’s a .0003458% chance of that causing breast cancer so…. no treatment for you. Basically if you didn’t read the fine print of your agreement or could in some way be blamed for your ailment then “you did this to yourself” and no coverage for you. Insurance companies can and did try to find any reason why you did not deserve full or any coverage for medial procedures and that did lead to fatalities (talk about death panels) because they’re goal is to make a profit and their stake holders happy.
Now, normally there’s nothing wrong with many markets making money and keeping their shareholders happy. If this was a tech firm no big deal right? That’s capitalism. But health care is a very different market.
Where we are now with the ACA
As I said earlier the ACA is a mixed bag of the good the bag and the ugly so first I’ll start with the good.
Children get to stay of their parents plan until they’re 26: To me this is common sense. I remember being 22 and fresh out of college. I got a job as a long term sub which did not have benefits, and I needed my wisdom teeth out. It was no sweat though because I was still covered under my parents and had the procedure with no worries. I feel very blessed to have graduated with no debt and having my health still covered. Otherwise once you get kicked from the comfortable nook of your college the bills come in almost immediately.
It eliminated the preexisting conditions. Now, you have to get the coverage that you pay for no matter what.
It covered holes in medicare drug laws that helped seniors
It made free preventative tests with medicare free. (An ounce of prevention is worth a pound of the cure right)
It also made free preventative tests for women for free
Ending awful lifetime caps for insurance
So if that was it, not a bad deal. Fixed some glaring holes, millions of people gained healthcare, what’s to hate? Well it also…
The employer mandate. Employers HAD to provide health insurance to their employees if they had more than 50 or face fines, which was crushing for small businesses.
New taxes. 20 new taxes were introduced in the bill
Overall higher insurance costs
Less choice in health care providers
The individual mandate: Be insured or be fined from the government.
I’m leaving a couple things out from both lists but those are the biggest highlights.
So… where do we go from here?
Republicans had some… interesting ideas. From setting up “health care saving accounts” to “not buying Iphones” but repealing the ACA, even with it’s flaws does not help get more people covered. Even expanding “access to healthcare” is not healthcare. I have access to emeralds, rubies, and diamonds are my local jeweler…that doesn’t mean I can afford it. Repealing the ACA is fine as it does have many flaws but it has to be a don’t throw out the baby with the bath water.
As I said before healthcare is not a normal market. In a normal market you can coupon clip for cheaper cereal. In a normal market you can wait for sales of “last seasons” shirts. In a normal market you can shop around for the cheapest airfare.
But this is the healthcare market. You cannot coupon clip to get a free appendectomy, you cannot wait until pancreatic cancer treatment is on sale, you cannot shop around for the cheapest deal on repairing a broken femur. These are matters of great significance and many times life and death. Capitalism does a great job of aspiring innovation, dropping costs, and creating competition for consumers…in most markets. Health care costs are often arbitrary and confusing.
Every other comparable country (and some that aren’t ) have some form of universal healthcare coverage. That’s not a perfect system either so don’t misunderstand me. You can find lots of Europeans who have gripes about their national system because that’s what people do, but I’ve not seen one non-American want to trade their healthcare system with the American system. And why should they? Let’s look at how the U.S. ranks in different healthcare categories.
Life expediency: US rank #31
Despite all our testing (which Americans do more than anyone) we still rank #31 some can attribute this to our diet or increasingly sedentary lifestyle but that is common among other developed nations as well.
Percent of GDP spent on healthcare: US rank #1 (17%) #2 France at 11% #3 UK at 8%
Yes, let that sink in. The U.S….which does not have a full universal system spends more on their patchwork of medicaid/medicare (as a percentage of GDP) more than any other country which covers 100% of their citizens. So any argument that says “hey at least we get a lot for our money” …do we? This of course doesn’t count the BILLIONS of dollars that is spent on healthcare privately, which where healthcare’s main revenue comes from.
Prescription costs vary but..
If you look at almost any prescription drug out there the U.S. is paying more for it. Not by a couple dollars but a lot more than our European/Asian counterparts. New Zealand does tie us for costs in one pill so… there’s that. But as a country that is becoming dependent on prescription pills to live healthy productive lives (whether it be pain pills, heart pills, depression/mental health pills, and many others) the price we pay is staggering by comparison. Here’s just a few examples.
- Copaxone (for multiple sclerosis) 2. Nexium (for heartburn)
U.K. pays: $862 per bottle Netherlands: $23 per bottle
New Zealand: $898 per bottle England: $42 per bottle
Switzerland: $1,357 per bottle Switzerland: $60 per bottle
U.S.A.: $4,038 per bottle U.S.A.: $215 per bottle
3. Enbrel (for treating autoimmune diseases) 4. Avastin (for treating certain cancers)
Switzerland: $1,017 per bottle U.K.: $470 per bottle
England: $1,117 per bottle South Africa: $956 per bottle
U.S.A.: $2,225 per bottle Switzerland: $1,752
I could list dozens of examples but you get the point. The U.S. does not do a good job regulating the sell of prescription drugs nor negotiating a lower sell. That’s because many drugs are made in America and their goal, just like other businesses is to make money. But at what cost? The U.S. is also #1 when it comes to adults skipping doses or not refilling pills based on costs and well the prices rise on prescription drugs, the quality of life suffers for those who need them.
Medical procedures also differ drastically from state to state but are also incredibly more in the U.S. than others. If you need a heart by-pass done that will ring you up an average of $743,000 in the U.S. compared to $42,000 in Australia.
It is an American quality to not want the government in our business. Our country was founded on a revolution against government tyranny so it is in our national D.N.A. to want the government intervening as little as possible in our lives. But, when you look at these numbers for a country that wants to be #1 in everything, when it comes to healthcare we’re only #1 in negative categories. We spend more G.D.P. than any other country on healthcare, we spend more of our own money on healthcare, we spend more than any other country on prescription drugs, we skip out on prescription drugs because of the cost more than any other country.
And what do we get in return? A suspected $750 Billion in waste. A pedestrian level of life expediency, at #31. We’re a respectable but not great in global happiness at #14. Also, those lower costs that other countries spend on treatments are 100% covered. There’s no caps, no deductible, no co-pays, just healthcare. We also see the doctor much less than Europeans, Asians, and Pacific Islanders, so it’s not as if they don’t use their healthcare services.
Americans without insurance have to go to the hospital too sometimes and if they can’t pay then guess who is stuck with the bill? Who is always stuck with the bill? You are, the tax payer. Even an ambulance ride will cost several thousand dollars, even if you’re unconscious and cannot consent to one. People with epilepsy, wear wrist bands asking kind-hearted people to NOT call ambulances in the event of a seizure since they don’t want to get a stiff bill.
So here we are in 2017 with the ACA still the law of the land, a poor band-aid on a bullet wound. As the gap between the rich and poor widens healthcare seems like more of a luxury (despite it being required by federal law) If we do not fix healthcare at it’s root cause we will continue to decline as a nation with sick people and even more sickening numbers.