Democrats Need to Talk Straight About Health Care

By Karen

Though I no longer have a dog in this fight because this month I finally got to enroll in Medicare, my hair still ignites when I hear the Democratic presidential candidates misleading us — whether in ignorance or intentionally, I don’t know — about how to reform health care.

If you’re confused about Medicare for All (a.k.a. “universal coverage”), let me explain the jargon…

Insurance – The crux of the problem. Candidates say “insurance” and “health care” interchangeably, but they’re totally different. Insurance is a piece of paper. Health care is visiting a doctor. The company who sold you the paper may not pay for your doctor’s visit.

Private Insurance – Candidates say this to mean insurance individuals buy for themselves AND insurance that employers provide for workers. Again, two completely different things. When dissing Medicare for All, candidates say, “People don’t want to lose private insurance they love.”

NOBODY loves true private (individual) insurance. It’s expensive because insurers cherry-pick and jack premiums based on age and health. It often has a high deductible, it can be canceled without warning when you get sick, and it can pay little to nothing on claims.

Employer-provided insurance is controlled solely by employers, who can change it, cancel it, or shift its cost onto workers. If you quit or get laid off or fired, you lose that insurance.

To control costs, both types of private insurance may lock you into “provider networks.” You see the doctors the insurer wants you to see, or go elsewhere and pay most or all of those medical bills yourself.

Affordable Care Act (ACA) a.k.a. Obamacare –Obama and Biden managed to pass this in 2010 over Republicans’ dead bodies for people who can’t get employer-provided insurance. It has an online marketplace a.k.a. “the exchange,” where you can buy insurance. Because the ACA didn’t go live until 2014, insurers spent four years royally screwing people (like me) who already had individual insurance by raising premiums astronomically.

ACA insurers on the exchange offer no discounts (see “Subsidies” below). Policies available on the exchange depend on which insurers do business in your area. It’s totally up to the insurers. There may several, one, or none.

Subsidies – Insurance premiums under the ACA are cheaper for people with low incomes because the federal government shovels billions of dollars in subsidies to insurers to make up the difference and keep them profitable.

Public option – Today, the ACA offers insurance only through insurance companies. The proposed “public option” is insurance provided by the government. The easiest way to have that option is to let people under age 65 enroll in Medicare.

Single-payer system – This would create a central federal billing and payment hub (think Medicare) that doctors would bill for providing health care for all Americans (universal coverage). There would be no paperwork for patients and it would have no co-pays, no deductibles, and no surprise bills. England, France, Canada, all of Scandinavia, and many other countries do health care this way because it’s more efficient and cheaper.

Medicare for All – The universal, single-payer system that eliminates insurance and pays for all Americans to receive health care from birth to death.

Here’s where some of the Democratic candidates stood in last night’s debate…

Joe Biden wants to keep the ACA and add the public option. Problem: insurance companies continue getting billions in federal subsidies that could otherwise pay for actual health care.

Pete Buttigieg wants “Medicare for All Who Want It.” He says people should keep private insurance if they like, which is bullshit if it’s employer-provided. He wants to keep subsidies to control costs, still shoveling taxpayer money to insurers to keep their profits up instead of paying for actual health care.

Amy Klobuchar wants to reduce premiums. She thinks punishing Big Pharma will do that. Insurance and drugs are separate industries; they have nothing to do with each other. The only overlap is when your insurance doesn’t cover your drugs and you have to pay full price.

This morning on Morning Joe, Klobuchar complained about Medicare for All kicking “149 million people off of their private insurance.” She’s another one confused about employer-provided insurance that workers have no control over.

Elizabeth Warren wants Medicare for All, but must be unsure of the numbers because she won’t say how she’d pay for it.

The ONLY candidate who fully understands the problem and how to fix it — because he “wrote the damn bill” — is Bernie Sanders. Under his plan…

No American will need health insurance. Instead, we’ll channel what we now spend on premiums, co-pays, deductibles AND surprise health care bills into one system.

A single, centralized billing and payment system will drastically cut administrative overhead and expense for the entire health care industry. This federal system will also have clout to negotiate lower rates for health care services.

You can go to any doctor. Networks won’t exist.

Not a penny from taxpayers will be wasted on subsidies to boost insurance company profits.

I believe, with Bernie, that not only will we all come out ahead financially, but no one will have to go bankrupt from disease or illness.

Check out this publication from the White House from March 2018 called The Profitability of Health Insurance Companies. It says insurance companies have done just dandy since the ACA took effect (emphasis mine)…

“As government policy amplified eligibility and per-enrollee spending, the stock prices of health insurance companies rose by 172 percent from January 2014 to 2018 resulting in improved profitability and outperforming the S&P 500 by 106 percentage points.”

And its conclusion says…

“Despite an initial rough patch in the ACA marketplaces, the ACA Medicaid coverage expansion and subsidies to insurers have resulted in a large increase in health insurer profits. Health insurers’ stock prices more than doubled the impressive gain in the S&P 500 since the law’s main provisions took effect on January 1, 2014. Much of insurers’ increased profitability has resulted from increased Medicaid enrollment and increased payments per enrollee in Medicaid expansion states where the federal government pays nearly all the costs. While insurers initially incurred losses in the ACA marketplaces as they adjusted to new regulations and a relatively unhealthy risk pool, insurers are now profiting on the individual market as well, with higher premiums that are largely covered by federal premium subsidies.

Bottom line: Any candidate, Democratic or Republican, who talks about subsidies, or even insurance, is for squandering our taxes to keep the biggest obstacle to health care — insurance companies — profitable.

6 Responses to Democrats Need to Talk Straight About Health Care

  1. bassgirl23 says:

    It’s interesting to watch this part of the debates from Canada. What’s an “average” cost of health insurance per month for you, and what does it cover?

    In BC, as in other provinces, we have the option of both private and single-payer (provincial) health care, although in BC we do pay premiums for the basic insurance ($75 / month for a family of 3).

    That ‘basic’ MSP (medical services plan) gets you access to pretty much any hospital or clinic for general care, and even if you don’t have it, you’re not going to be turned away if you show up at a hospital needing urgent care. But for ongoing costs for prescriptions, and for dental and other providers like physiotherapists etc., you really do need some additional level of private insurance – MSP covers only the basics, and not always in a reasonable amount of time.

    Many employers offer private plans as part of your benefits, and they pay some to all the monthly cost – depends on the employer. Currently my employer pays $450 / month for my policy, which covers both me and my family. It covers about 80% of the cost of most services (including dental) – the rest is out of pocket. My husband’s union pays for his plan as well (not sure of the cost, but it also covers the entire family). His plan is with a different insurer, which often results in us having 100% coverage. His plan also covers some things mine doesn’t (like counselling). We can go to almost any doctor or provider, but not all operate the same way – some don’t accept MSP up front, and some do but then still make you pay a “user fee” (which may or may not get reimbursed). I’d say we probably still pay about $2,000 out of pocket per year for things that aren’t covered or are covered but only at a minimum $ level (massage therapy, physio, etc.)

    MSP wait lists are long in our province- eg up to 2 years for a hip replacement, 8 months for an MRI, 6 months or more to see a specialist – and it can get ridiculously over-complicated when trying to submit claims, waiting for the determination of who pays first, what they’ll pay or won’t, and then following up with the other insurer to get reimbursed for the balance. It’s the ultimate make-work scenario (although many plans now have direct billing). And if you’re injured at work or in a car accident it just adds another level of paperwork and bureaucracy trying to coordinate which insurer pays for what and when.

    There’s still very much “2 tier” care here, even though overall it is pretty good. You can pay to expedite most surgeries, as we do have private surgical clinics (although there’s currently a court challenge about that). Many high-income professionals now belong to private health care clinics where you pay a yearly fee (usually $5-10k per person) for fast access to a group of doctors and services operating mostly outside the MSP system.

    Sometimes we’ve gone into the private system here – when my husband needed an MRI, we paid $800 to get one within a week rather than wait 6 months in the public system. But when his knee was injured at work, he got the MRI within a month (paid for, because it’s a different insurer). And then his knee surgery was only a 2 month wait rather than 10-12 months. My physio is covered right now because it’s a result of a car accident…. but only until I settle with the auto insurer. Then, if I need physio for my back in the future, my medical insurer won’t pay for it because it’s from the car accident, so I may end up paying out of pocket.

    I guess what I’m saying is our system is good, but it sure isn’t perfect. Even single-payer is overly bureaucratic and still has more levels than you’d think!

  2. catsworking says:

    That’s all very interesting about the Canadian system, bassgirl. I think even with a single-payer system here we would still have private insurance as an option for elective surgery or other “frills.” The insurers wouldn’t totally disappear, but they’d become a niche market.

    Until I went on Medicare (which will cost me $250 a month, I had heavily subsidized policy through the ACA exchange. I was paying $185, but without the subsidy it cost $1,065 a month. The deductible was I think a bit over $3,000.

    In Medicare world, I have 4 separate policies. Regular Medicare for hospital and doctors, a supplemental policy to cover what Medicare doesn’t, a separate drug policy that’s cheaper than what Medicare charges, and a separate dental policy because Medicare doesn’t do teeth.

    I was stunned at how complicated it was to get set up on Medicare. I spoke to multiple agents before picking my plans, and I stay on top of this stuff, so I’m a bit more savvy than the average bear. I have been getting bombarded all year by mail about Medicare Advantage plans (which have a lot of added gimmicks like gym memberships, but you’re limited to networks and my doctors don’t accept most of those plans. The policies I got let me see any doctor that accepts Medicare). Just when people are getting old and mentally lazy, they get hit with this INFURIATINGLY complex web of insurance choices to navigate.

    We also have these boutique practices that charge people thousands for instant access to their doctor. Wait times aren’t as bad in general, except for specialists, where it can take months to get appointments.

    But the cost of all health care is through the roof. If you don’t have insurance that forces the doctor to accept vastly reduced payments, the price of the simplest procedure can be many hundreds. I think my last routine visit to the doctor to get prescription renewals would have cost me $250 just to have him walk in the room if insurance hadn’t covered it.

  3. Mary Hunter says:

    I can’t hardly comment because it makes me so angry. If the cost of other things in our lives went up as much as health insurance, there would be rioting in the streets! But we all just sit back and take it, as the health care costs go through the roof.

  4. catsworking says:

    Mary, what makes my blood boil is that the politicians keep talking about “insurance” and “coverage” as if they are the answers. But they IGNORE the real problem, which is that doctors and hospitals are allowed to pull numbers out of their asses when charging people for services. THIS is what needs to be regulated — HARD.

    They’re going after the drug companies because they’re low-hanging fruit. Yes, they caused the opioid crisis and are actively killing people for a profit. Great. Everybody knows that. It’s a slam-dunk. Prosecute and regulate the holy fuck out of all of them. They’ve made billions, they deserve it.

    But next should come the whole health care industry. The secret “charge master,” which is a vast nonsensical list of what hospitals charge for things, should be put under a microscope to root out the abuses and then shredded. Until we take control of the unworldly expensiveness of every single little procedure, no plan to pay for it will be able to keep up.

  5. Robert Smith says:

    I agree with you. When turning 65, if you have no employer health insurance, you MUST sign up with Medicare. As far as I remember, if you don’t sign up, the government threatens to take your Social Security. I am on Medicare, yet have to pay out of pocket for my medication because Medicare won’t cover the medicine I’ve been on for 25+ years, whereas it was covered through our private health insurance’s prescription plan.

  6. catsworking says:

    Welcome, Robert. I’m 99.999% sure you can’t lose Social Security if you don’t enroll in Medicare. They’re two separate programs having nothing to do with each other. If anybody’s making threats about that, I can only guess who, and it wouldn’t be Democrats.

    I turned 65 last year, self-employed for 18 years so I haven’t had the luxury of cushy employer coverage for that long. I bought my own individual health and dental policies. Now, with Medicare, I replaced those two with four policies to cover the same things:

    – Medicare Parts A and B for hospital stays and office visits

    – Medical Supplemental (Supplemental, NOT Medicare Advantage) policy to cover what Medicare doesn’t. It doesn’t limit me to a narrow network of doctors, as the Advantage plans do.

    – Dental policy (same as I had before)

    – Drug policy (because it was cheaper than Medicare Part D, or covered my prescriptions more cheaply, I don’t remember which, just better than Medicare)

    It’s costing me about $60 more a month than my previous individual coverage, but so far, so good. I haven’t had to pay a penny for my three generic prescriptions, nor for a flu shot nor a pneumonia shot. I haven’t been to the doctor yet, so I don’t know how that will shake out.

    You can change your drug coverage every year during the Medicare open enrollment period, which I think starts each October. I went to the Medicare site and compared drug plans offered in my area to see which one covered my prescriptions most cheaply. It was WellCare. You might try that next October to see if a separate policy would do you better than Medicare Part D.

    They certainly don’t make it easy for seniors to get the best coverage most affordably. You have to do your homework. I had no idea it would be so complicated.

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