Affordable?

Where ObamaCare went wrong.

The Affordable Care Act — or ObamaCare, as I prefer to call it, giving credit where credit is due — is a wonderful panoply of the entertaining, the frustrating and annoying to me.

• Entertaining, as it is quite amusing watching a bunch of politicians trying to implement socialized medicine and ending up with a curious hodge-podge of Marxism, Capitalism and Corporatism.
• Frustrating, because I have personally experienced the costs of a piece of legislation that was so complicated that we had to pass it to find out what was in it (thanks Nancy!).
• Annoying because I work — indirectly — in the Healthcare industry, and have seen and have had to deal with the direct knock-on effects and consequences that have resulted from the introduction of this legislation.

What they did:

• Insurance for everybody! At some point somebody decided that Health Insurance was a fundamental Human Right, and that we should all have Health Insurance. Pity the 90% of the people on this planet have never heard this.
• That’s an order! The Supreme Court has bought into this flummery to the degree that they ruled that it was a crime to refuse Health Insurance if it was offered to you.
• Expand Medicaid! Free coverage for the poor! Sounds good, but who’s going to pay for this? More on that later.
• Abolish Pre-existing conditions: Depending on who you ask, this was either one of the few good things that came out of the Affordable Care Act or an affront to Free-Market Capitalism. Until now, insurance companies could refuse to insure you if you had a pre-existing condition.
• Abolish annual and lifetime caps. Nobody wants unlimited liability and exposure, and Insurance Companies are no exception. A Heart Transplant costs millions… and nobody wants to pay for that.

Unintended Consequences:

• The words: “If you like your health care plan, you can keep it” will go down in history as one of the great presidential lies of all times, along with “Read my lips, no more taxes“, “I am not a crook“, and “I did not have sex with that woman“.
• The first consequence of Obamacare was that premiums went up significantly. So much so that my employers dropped the HMO and PPO options that they had been offering, leaving only the High-Deductible Health Plan (HDHP) — the cheapest option for them, and the most expensive for those of us who are not young and healthy. The good news is that I now pay about 20% less for health insurance. The bad news is that I am on the hook for the first $10,000 of expenses, Since I have a dependent who has severe allergies and Asthma, I am about $6000 a year worse off than before. Thanks for the pay cut, your Obama-ness.
• Only the largest groups get a good deal: My employers are not a large company, so they get a crappy deal from the Insurance Companies. Big organizations like Federal and State Government, Home Depot and Wal-Mart can use their size to get a better deal.
• Doctors don’t get paid. Under HMO/PPO, the patient pays a Co-Pay. Under HDHP, the entire bill goes to the insurance company where it is “adjusted” and then gets passed on to the customer… who ignores it for several months. Medical bills are now at the back of the line to get paid after just about everything else.
• Insurance companies won’t to answer the phone: “All of our agents are busy at the moment”, “call volume is exceptionally high at the moment”, and “We can’t come to the phone right now” all mean the same thing WE DO NOT HAVE ENOUGH EMPLOYEES.When even your local pharmacist is getting having their time wasted by the IVR run-around, something is rotten in the state of Denmark.

What they should have done:

• Removed or phased out the incentive that enabled employers to offer Health Insurance.
• Added tax breaks for individuals who purchase private health insurance. or added the incentive to private buyers.
• Favorable tax treatment to Health Care Professionals who provide free services.
• Made *all* medical expenses tax-deductible, and abolish that stupid AGI requirement.
• Removed all sweetheart in-network deals for Insurance companies – the original idea behind the HMO was that the insurance companies paid top dollar so that the uninsured could get free or low-cost treatment. This lasted until the Insurance companies realized that there was money left on the table that they could grab.
• Broken the AMA-induced doctor shortage by introducing government-backed training for doctors and/or allowing Nurse Practitioners and Midwives to practice medicine in limited situations without a Doctor present.
• Introduced menu pricing or allowed patients to negotiate prices directly, with governmental oversight in place when this is not possible.
• Reduced our reliance on Employer-provided Health Insurance: Employer Health Insurance first became popular during the Carter years; with a wage freeze in place, employers scrambled for a way to keep their best employees, and this was one of the “perks” that they came up with. There is no definitive reason why Health insurance has to be the province of employers!
• Divided healthcare into acute care (private) and chronic care (public) components, let the private sector handle the former and the Government handle the latter.
• Prohibited conflict-of-interest situations like Insurance companies involving themselves in providing (cheap) medical care.
• Required that Insurance Companies answered the phone. Not sure if there is any practical way to do this.

Of course, none of these things were going to happen, since they all result in a cost to the Government, the Health Insurance companies, or the Doctors.

And we can’t have that now, can we?