Why such differing opinions on the ACA?

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Category : Medical Rants

We have a major philosophical disagreement concerning the ACA. I have tried to watch both MSNBC and Fox News. I read both “liberal” and “conservative” columnists. Unlike too many Americans, I have not just read and watched those who reinforce their own opinions.

As one reads the NY Times editorial page and watches MSNBC, one finds some consistent themes. Today’s NY Times editorial makes that point. Insurance Policies Not Worth Keeping.

Mr. Obama clearly misspoke when he said that. By law, insurers cannot continue to sell policies that don’t provide the minimum benefits and consumer protections required as of next year. So they’ve sent cancellation notices to hundreds of thousands of people who hold these substandard policies. (At issue here are not the 149 million people covered by employer plans, but the 10 million to 12 million people who buy policies directly on the individual market.)

But insurers are not allowed to abandon enrollees. They must offer consumers options that do comply with the law, and they are scrambling to retain as many of their customers as possible with new policies that are almost certain to be more comprehensive than their old ones.

Indeed, in all the furor, people forget how terrible many of the soon-to-be-abandoned policies were. Some had deductibles as high as $10,000 or $25,000 and required large co-pays after that, and some didn’t cover hospital care.

This editorial, and the law in general, take a paternalistic view of health insurance. This is the philosophical position that defines the problem. The response to policy cancellations and marked increased insurance costs is typified in the final paragraph above. This represents the current talking point – bad insurance. But who should determine what defines bad insurance?

When reading the opposition press, comments, and watching Fox News this criticism defines their concerns. Charles Krauthammer wrote recently – Obamacare laid bare

Beyond mendacity, there is liberal paternalism, of which these forced cancellations are a classic case. We canceled your plan, explained presidential spokesman Jay Carney, because it was substandard. We have a better idea.

Translation: Sure, you freely chose the policy, paid for the policy, renewed the policy, liked the policy. But you’re too primitive to know what you need. We do. Your policy is hereby canceled.

Because what you really need is what our experts have determined must be in every plan. So a couple in their 60s must buy maternity care. A teetotaler must buy substance abuse treatment. And a healthy 28-year-old with perfectly appropriate catastrophic insurance must pay for bells and whistles for which he has no use.

It’s Halloween. There is a knock at your door. You hear: “We’re the government and we’re here to help.”

You hide.

Those who argue opposite sides of this issue do not understand each other. The administration and their supporters believe that government’s job is to protect citizens from their bad choices. They want to decide what the people need and thus impose regulations. The opposition wants the right to make their own decisions about what defines good insurance.

Our painter has a family of 5. He had private insurance that he found acceptable. Now his insurance fees are increasing $700 per month. He cannot work harder – he works very hard and cannot work any harder. So this law markedly decreases his effective income. He is angry.

Krauthammer and his philosophical allies find this hard-working man a symbol of government excess. Apparently the NY Times, without knowing any details of his expired insurance, opines “Indeed, in all the furor, people forget how terrible many of the soon-to-be-abandoned policies were”

The philosophical divide remains wide. Our current system has losers. We all understand that. Most citizens did not understand that this new law would create different losers. What is fair? Our collective answer may well define upcoming elections.

Comments (4)

” So a couple in their 60s must buy maternity care. ” Is this a fact?

Our painter has a family of 5. He had private insurance that he found acceptable. Now his insurance fees are increasing $700 per month. He cannot work harder – he works very hard and cannot work any harder. So this law markedly decreases his effective income. He is angry” – Would he not qualify for a subsidy? Has he done the research to make sure this is the lowest premium? Is he mad because he would now not be summarily kicked off this new plan? That, God forbid anyone of his family were diagnosed with cancer and have to chose between chemotherapy and bankruptcy, if it were not for the ACA? It is a complex problem and one has to dig deeper than the price of the premium IMHO.
Robert Modugno MD MBA FACOG
Georgia – where at least 400,000 gerogians will have no insurance because of the state’s refusal to accept Medicaid expansion.

The debate is very real on a personal level for many Americans. This link is only an indication of the problems many face:

http://thehealthcareblog.com/blog/2013/11/02/the-aca-may-kill-me/

I had a union plumber at my house doing work. His monthly insurance premium including his wife and 16 year old son is already $1,200 per month, how does he accept a higher premium? This is not a family budget issue, but an issue that reflects a family’s ability to buy a home, car, education choices, or even what they will eat.

We have yet to learn what other countries already know; you must control medical cost and allow the economy to grow. Those who wish more than basic care are free to purchase anything they want with their own money. Those who wish basic coverage with a catastrophic rider are also allowed that option.

Both sides have focused on those unusable policies while ignoring that many purchasing coverage are finding they in essence are buying high deductable policies in order to maintain some semblance of financial reality.

Steve Lucas

“Those who argue opposite sides of this issue do not understand each other. The administration and their supporters believe that government’s job is to protect citizens from their bad choices. They want to decide what the people need and thus impose regulations. The opposition wants the right to make their own decisions about what defines good insurance.”

And with that statement you may be falling victim to your own description of the logical errors of others. First, both sides believe in a regulated insurance marketplace. There are states with more and less regulation of health insurance, but no state makes it a free-for-all. Neither side has proposed modifying ERISA, which as you know imposes significant regulation on group policies and extends many of the protections now being extended to people in the individual market under the PPACA. Neither side is proposing that EMTALA be repealed. While you may be right that one side is more likely than the other to pound its chest and whine about bureaucrats, if you look at their actions you’ll not find much difference in how they treat insurance companies.

Second, the notion that this is about protecting people from their own bad choices is not supported by the debate or the content of the law. It’s principally about giving people who have historically been frozen out of the market for quality health insurance the opportunity to buy in. This isn’t an idea that originated on the left – along with the individual mandate, it’s an idea straight out of the Heritage Foundation, and was first legislatively implemented in Romneycare. The “paternalism” of requiring mental health parity or better prescription coverge is the same sort of “paternalism” G.W. Bush and the Republican Parties delivered through the Mental Health Parity Act of 1996 and Medicare Part D.

The current demagoguery about individual choice is a distraction. Sure, many people are losing the right to choose a policy that is apt to leave medical facilities holding the bag (and passing the cost on to its other patients) when their bare bones insurance leaves them with a huge, unpaid medical bill, but they gain the right to “choose” a policy that would prevent you from having a large, unpaid medical bill.

It hews closer to libertarian ideals to say, “But people should have the right to roll the dice, and free ride or carry insurance policies they know won’t cover their needs if they are injured or become seriously ill,” but society at large has the right to say that the free rider phenomenon and the inflated cost of health care and health insurance that results from having large populations of uninsured and underinsured persons. Eliminating free ridership and that type of redistribution of wealth may have been abandoned by the modern Republican Party, but is consistent with conservative political principles.

“Would he not qualify for a subsidy? Has he done the research to make sure this is the lowest premium?”

My guess is that he is talking about a letter he received from his insurance company, telling him that his existing plan is being cancelled and that unless he cancels his policy he’ll be ‘automatically enrolled’ in the more expensive plan effective Jan. 1. Pretty much every time I hear a story like this, the afterword turns out to be, “When he looked at the exchanges he found a better price, and that he qualified for a significant subsidy.”

I received one of those letters from my insurance company, by the way. The one I received was not as misleading as those I’ve seen described from other companies, but it omitted any mention of subsidies. It didn’t occur to me that this was an issue, as I won’t qualify for subsidies, but that omission could be highly misleading to many people who are eligible.

Having looked at my post-ACA options, I find that the coverage is much stronger than what came before. An individual can now purchase insurance comparable to that which was historically achievable only through a large group plan, at a price comparable to that which was historically available only through a large group plan. That’s pretty amazing. Those plans (silver and up) are not cheap, but provide a great deal more predictability in terms of your annual medical expenditures. Perhaps you have to have been insured through a private plan to realize that this judgment is not political: bronze plans are better than much of the junk they displace. Somebody who would have chosen a bronze or lower plan due to pricing now has the option of getting better coverage at a higher premium but possibly at a lower annual cost due to expanded coverage and almost certainly at a lower out-of-pocket cost in the event of an unforeseen serious illness or injury – and with no worries about hitting a lifetime cap on benefits or being declared “uninsurable” when you try to shop around for another policy.

“I had a union plumber at my house doing work. His monthly insurance premium including his wife and 16 year old son is already $1,200 per month, how does he accept a higher premium? ”

As a “union plumber”, it is reasonable to infer that he purchses his insurance through the union, so if his insurance costs are going up on Jan. 1 that would be mostly or exclusively due to normal changes in the market, not due to the effective date of the mandate and exchanges.

“We have yet to learn what other countries already know; you must control medical cost and allow the economy to grow.”

Which”other countries” do you have in mind? Because most developed nations achieve their lower medical costs by negotiating lower reimbursement rates to providers and pharmaceutical companies, not by denying care or demanding huge contributions from patients. Canada has no compayments for health care. Germany has a $10 quarterly copayment for doctor visits if you want to pick your doctor, but none if you are willing to take an appointment with the next available doctor in a given medical practice.

Be careful when comparing apples and oranges. The situation gets devilishly complex in a big hurry, depending on the individual needs of the insured and the previously available coverage. Certain questions need asking.

Many patients are learning that their current physicians are not par with the new plan.

Many top hospital systems are opting out as well –
http://www.nationalreview.com/corner/362757/top-hospitals-opt-out-obamacare-wesley-j-smith#!

So now you have to find possibly a new doctor and a new hospital should the need arise.
Finally, many of the new plans do not have any out of network benefits. This complicates matters should you need the services of one of those hospitals opting out – one which quite possibly would have taken your previous coverage.

Without getting into the issue of why young single men need coverage for maternity care, there are potential issues for many who are looking into purchasing new health insurance.

Without taking sides here, the issue will probably be answered differently depending on individual situations. And that may be the ultimate problem with the ACA – in many areas, the choices are somewhat less than robust.

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