Democrats Need to Talk Straight About Health Care

October 16, 2019

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.


Time to Rename GOP Health Bill #TrumpDontCare

June 28, 2017

By Karen

Because he doesn’t, never has. Donald Trump has no clue what’s in the Senate’s “Better Care Reconciliation Act.” Ditto the House’s “American Health Care Act.” He never read either bill because this is how he reads, according to Reuters

“Conversations with some officials who have briefed Trump and others who are aware of how he absorbs information portray a president with a short attention span.

He likes single-page memos and visual aids like maps, charts, graphs and photos.

National Security Council officials have strategically included Trump’s name in ‘as many paragraphs as we can because he keeps reading if he’s mentioned,’ according to one source, who relayed conversations he had with NSC officials.”

But that didn’t stop Trump from hosting a celebration in the Rose Garden after the House bill passed, although it faced certain doom in the Senate.

In naming their bill “Better Care,” I assume Republican senators meant they’re taking better care of millionaires like Trump because they’re reducing his taxes while sticking it to the rest of us by letting health care costs spiral beyond reach for the poor or disabled, children, and older people.

God forbid they should ever focus on the real problem — pharmaceutical companies, medical providers, and insurers charging whatever they want to maximize their profit on sickness and death. To address the root cause of this health care disaster would stop those sweet, sweet lobbyist bribes from flowing into lawmakers’ coffers.

The one thing Trump does know about the existing Affordable Care Act (or “Obamacare,” as the GOP likes to disparage it), is that insurers are pulling out of state health insurance exchanges. That’s a fact. But they’re not going bankrupt. They’re just not raking in as much profit as they’d like.

In Trump’s feeble brain, this alone represents “complete disaster” and “melting down,” while he ignores that the law contains provisions people will not give up without a fight, such as no lifetime caps on coverage and not being denied coverage or charged more for pre-existing conditions.

Read how the ACA actually compares to the two Republican bills.

Trump makes his ignorance apparent by never mentioning specifics. During the campaign, he promised “something terrific” that would cover everyone and cost a lot less — without one detail about how he’d do it.

Once in office, he whined that health care is “a lot more complicated” than anybody ever knew. Wrong. Anybody who followed the ACA struggle into existence knew it but TRUMP. Because he didn’t care. It didn’t affect him.

Amazingly, Republicans can’t muster the Senate votes to ram their bill through because a few of them apparently have consciences, so they’re delaying the vote until after the July 4 recess.

Yesterday, Trump ordered, as if they’re his personal serfs, all the Republican senators onto buses to the White House. Spouting nonsense and still showing no idea what he was asking for, Trump just urged them to pass the bill. Watch it here…

http://www.reuters.com/assets/iframe/yovideo?videoId=371976494

The bottom line is #TrumpDontCare about anybody’s health care. He’s exploiting the ignorance of his base on a hot-button issue to cut his own taxes. Then he’ll claim it as a YUGE legislative achievement. It will take some time before the rubes realize Trump betrayed them and they’re worse off than ever.

Democrats, (I’m looking at you, Nancy Pelosi), PLEASE listen to Elizabeth Warren and start pushing for Medicare for All, a single-payer system. It’s the only option left. Channeling premiums now shoveled at health insurers into one government-run system will eliminate most administrative waste. Those savings will pay for actual medical care. A single, strong government entity will have the power to crush the price-gouging of drug companies and medical providers. For-profit health insurance companies will be remembered only as a bad dream we shook off.

It’s a supreme irony that a single-payer system will actually make Trump’s promises of terrific health care for everyone at less cost come true. But I’ll take it anyway.

BONUS: I came across this look at Trump by Carlos Lozada wrote in 2015 after binge-reading eight of Trump’s books. The last line of the piece is particularly revealing about Trump in the White House.


Bill Clinton’s 100 Percent Correct on Obamacare

October 6, 2016

By Karen

Bill Clinton’s catching hell for calling a certain aspect of the Affordable Care Act — NOT the whole program, mind you — “the craziest thing in the world.” And this is what he said (quotes taken from CNN)…

“But there is a group of people — mostly small business owners and employees — who make just a little too much money to qualify for Medicaid expansion or for the tax incentives who can’t get affordable health insurance premiums in a lot of places. And the reason is they’re not in big pools,” Clinton said. “So they have no bargaining power.”

“So you’ve got this crazy system where all of a sudden 25 million more people have health care and then the people who are out there busting it, sometimes 60 hours a week, wind up with their premiums doubled and their coverage cut in half. It’s the craziest thing in the world,” Clinton said.

I’m EXACTLY who he’s talking about. I’m a sole proprietor with individual health insurance, and I earn a little too much to qualify for any subsidy from the ACA.

In the past two years, my premium has gone up 52%. I’m still three years short of qualifying for Medicare, so I just dug into savings and paid off my mortgage because I fully expect my health insurance premium to become so crushing, I won’t be able to continue paying both.

Trump, of course, is cherry-picking Clinton’s statements as agreement with Republicans. That’s because Trump doesn’t have a clue what he’s talking about. All Trump’s said is he’d replace Obamacare with “something terrific.”

But Bill Clinton is spot-on about the ACA’s biggest weakness. I thank him for bringing it into the conversation.

Hillary favors adding a “public option,” but as long as greedy private insurers continue to gorge themselves at this trough, raising premiums AND collecting government subsidies, Americans will continue being screwed while having unaffordable access to healthcare.

The ONLY solution is a single-payer system — Medicare for all — with EVERYONE (including employers if they keep offering coverage to employees) paying into one central, not-for-profit pot. Done right, it would eliminate copays and deductibles. These are the additional costs that become deal-breakers when piled onto already-high premiums.

We’d ALL come out ahead in the long run.


Obama’s “Mission Accomplished” Moment

April 2, 2014

By Karen

After how it haunted George W. Bush, you’d think President Obama would be wary of claiming a premature victory, but no. Those who ignore history are doomed to repeat it.

In spite of myriad obstacles his breathtakingly incompetent administration created (WHY, after the website debacle, does Kathleen Sebelius still have a job?), 7.1 million Americans managed to sign up for health insurance under the Affordable Care Act.

If nothing else, their patience speaks volumes about the dire state of medical care in this country.

And Obama and Biden are gloating. Watch them, if you haven’t just eaten.

Anecdotal evidence is that, in some states, people are getting much-needed medical care with government-subsidized health insurance, and that’s fantastic. But for those of us in states where Republicans worked overtime to sink this law, and who earn just enough to qualify as middle class, there’s no joy in Mudville.

My premiums have gone up, my deductible is still high, and my coverage is no better, except I think the lifetime cap may be gone. But who cares? If I ever get sick enough to test that, I’ll be half-dead anyway.

It’s a matter of time before the horror stories start — and some already have — from people who discover they’ve been duped. They can’t keep their doctor because their policy’s super-narrow network excludes him.

They can’t get medications they need because the policy excludes them.

And they can’t get leading-edge treatments at the facility that offers them because it’s out of network.

Obama gave insurers 4 years to exploit every loophole to their advantage, and they did.

And it’s only a matter of time before we start reading that insurer profits are breaking all previous records. They’ve just been handed 7.1 million more victims customers and a steady stream of government subsidies.

Watching Obama crow about insurance is stomach-turning. He’s thrown us all under the bus to enrich insurers who were already raking in billions in profit that doesn’t buy a penny’s worth of medical care, and he’s delighted.

I can’t tell you how much I hate siding with Republicans on this, but Obama’s “mission” on healthcare is hardly “accomplished,” and he’s going to find out soon enough — unfortunately, at our, and probably the Democrats’, expense.

Universal healthcare, with its economies of scale, is the ONLY way to ensure that the max of what we invest in healthcare actually buys medical care. The system (it’s called Medicare) is already in place. Just expand it to let the rest of us in. If all the premiums we’re squandering on sustaining insurance companies were channeled into it, it would thrive. Exclusions and network constraints would disappear. Employers could end the expense and hassle of insuring workers. Workers wouldn’t be stuck in jobs they hate because of health insurance.

Vermont Senator Bernie Sanders agrees that access to medical care should be a right of all Americans, and he’s introduced the American Health Security Act of 2013 to get us there, which the Affordable Care Act never will.

It deserves a serious look.


If You Like Your Worthless Health Insurance, You Can Keep It

March 5, 2014

By Karen

Obama’s doing such a good job himself of walking back the requirements of his Affordable Care Act, Republicans don’t need to waste any more time trying to repeal it.

Now Obama’s letting people continue to keep policies that don’t meet minimum ACA coverage requirements — possibly for as long as 3 more years. Why? To make it appear he wasn’t lying when he stupidly said, “If you like the insurance you have, you can keep it.”

Here’s the problem with that: Those policies are cheap because they were sold to people who either 1) Think they’ll never get sick, or 2) Didn’t understand how little insurance they were buying.

I’m talking about those hapless schmucks we see on the news occasionally after something catastrophic happens to them and they find themselves bankrupted by medical bills because their el cheapo insurance won’t pay their claims.

Insurers make damn sure their policy documents are so voluminous and opaquely worded that the average consumer needs a Ph.D. in insurance jargon and unlimited time and patience to wade through all the conditions and exclusions.

That’s precisely why insurers need to be kicked out of the healthcare equation in favor of a simpler system. But I digress…

Letting people keep garbage health insurance does them no favors. It just keeps shoveling ill-gotten gains into insurers’ pockets. Between high deductibles and copays and avoidance of the “no-cost” preventive care mandated by the ACA, these premiums must be mostly gravy for insurers because little gets paid out in claims.

On a personal note, Anthem showed me a wisp of mercy to keep me out of the exchange on my March renewal, raising my premium from $392 a month to $413.75, a modest 5.5% increase. But since 2011, they’ve raised my premium 66%.

My policy has a $2,250 deductible, but meets ACA requirements (which Anthem has used to justify hitting me with 15% and 20% yearly hikes since the ACA first passed donkey’s years ago).

I haven’t done 2013 taxes yet, so I don’t know if I can qualify for a subsidized policy on Healthcare.gov. But even if I do, I’m afraid to take advantage of any savings and lose the dubious security of my current policy.

At the lengths he’s taking to protect insurer profits at the cost of people getting better access to medical care, Obama seems poised to pull the rug out from under himself and gut the ACA. That means insurers will once again have free rein to continue raping and pillaging the American healthcare system.

I hate the policy I have, but Obama’s made me afraid not to keep it.


GOP Says: If You Hate the Job You Have, You Should Keep It

February 10, 2014

By Karen

If you wake up every morning wishing you’d died in your sleep because you dread facing another day at your job — but you drag yourself to it anyway because you need the health insurance — Republicans think that’s exactly how you should live.

That’s the message the GOP is crowing loud and clear in their deliberate misreading from the CBO report that the Affordable Care Act will cut 2.5 million jobs over 10 years. They’re slavering at the prospect of employers tossing several million more workers into the gutter.

They’re thrilled to claim that Obamacare will trample the little guy, yet hypocritical enough to label it a bad thing, as if their own raison d’être isn’t to destroy the 99% in the name of further enriching the 1%.

Unfortunately, what’s they’re saying is all lies.

The CBO report actually says…

CBO estimates that the ACA will reduce the total number of hours worked, on net, by about 1.5 percent to 2.0 percent during the period from 2017 to 2024, almost entirely because workers will choose to supply less labor.

People will cut back on hours, retire early, or start their own businesses because THEY DON’T HAVE TO WORRY ABOUT LOSING THEIR HEALTH INSURANCE.

Lack of portability is one of the most corrosive aspects of our healthcare system. Just for insurance benefits, companies have people on the payroll just going through the motions of jobs they hate. Have you ever gotten no help whatsoever from a so-called “customer service” rep? Yeah, that’s who I’m talking about.

Those miserable souls who are nothing more than deadwood on the payroll, contributors to workplace dysfunction, can now move on and be happy.

This one bona fide silver lining in the Obamacare mess has the GOP wallowing in a La-La Land fantasy of the death of the American workplace as we know it.

Just read John Boehner, Paul Ryan, and Orrin Hatch all being quoted by Fox News. You can almost feel them drooling.

The bottom line is that employers never should have put themselves in control of anybody’s health insurance in the first place. Being employed and getting medical care should be mutually exclusive.

But hindsight is 20/20.

For all its many flaws, the ACA is taking the country in the right direction in breaking the link between healthcare and employment — for those who can get decent policies for a reasonable price on the exchanges.


Happy Freaking New Year, Obama

December 31, 2013

By Karen

I may have voted for him twice, and his family recently sent me a lovely Christmas card, but I have come to loathe President Obama. Since I got onto Healthcare.gov to check out the possibilities for insurance, I’ve been unable to bring myself to look at or listen to that man.

And just when I thought he couldn’t get any worse, he jabbed a thumb in our eye by “buying” some token bronze policy for himself.

Let’s be clear: Obama didn’t personally deal with Healthcare.gov. He had people for that. And they claim he personally picked the plan, and intends to pay for it himself.

How ducky. His lousy little policy will never be tested because he’s got government medical care.

Meanwhile, I await word on how high my current Anthem policy (which is grandfathered, so “I can keep it” even though I’ve never liked it) will go when it renews March 1.

Everything I see on Healthcare.gov is even worse — higher premiums, higher deductibles, no dental — as incredible as that may seem, if you’ve soaked in any of Obama’s lies about how great the plans are.

To compare apples to apples: My current policy is $392 a month, with a $2,250 deductible and dental.

On the site, Anthem offers a silver HMO with a $2,250 deductible and NO dental for $534.

That’s why I’m sweating.

And now the Obama folks are crowing because more than a million people think they managed to overcome all website-inflicted obstacles and buy insurance.

Many of them are THRILLED they got premium subsidies. These trusting souls haven’t had insurance in YEARS, and have no idea what’s coming when the other shoe drops.

And it will.

Just wait until they finally see a doctor and the bills start rolling in because they’re on the hook to cover a $6,300 annual deductible before insurance pays a penny. That’s the cheapest ($342/month) bronze Virginia plan.

Obama graciously gave insurers nearly 4 years to plot how to thwart the ACA’s intent, and they’ll use sky-high deductibles to deny claims willy-nilly on all those “affordable” plans.

We’ll soon see people with shiny new Obamacare crying the blues because Obama & Sebelius utterly FAILED to inform them that Job One is for us to keep insurers profitable, while insurers take as much of our money as they can and provide NOTHING in return.

An excellent (albeit annoying) video called cureALL recently came out to explain the reality of health insurance to young people — as Obama should have done, if he were honest. It concludes by advocating single payer as the ultimate solution, through the bill HR 676, which I was pushing back in 2008.

I hope young people get the message and let insurers and Obama swing in the breeze by refusing to play the game. I hope they can finally make Congress get serious about HR 676.

At this point, it’s our only hope.


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