Sunday, November 17, 2013

More on the Affordable Care Act plus an Intergenerational Story from Sid

More on Obamacare 

Supplementing the last posting’s comments (go back and read it!) on technology and the Affordable Care Act, I think I must make it clear that the reason some employers were dropping group coverages and insurance companies were either cancelling or raising the premium on existing individual health insurance policies was that these policies did not meet some of the minimum standards called for by the Act.
Cancelled Policies Didn't Meet ACA's Minimum Standards

The alternative to cancelling such cut-rate cheap policies was to increase their premiums so that they were properly priced to provide at least the minimum coverage the ACA requires.  For example, an individual or employer-provided policy which doesn’t include paying for mammograms would have to be higher priced to provide that benefit as called for in the Act. 
The real question which the government faced was whether insurance companies should be allowed to keep these less expensive policies not meeting ACA’s minimum standards in effect.  Other than for a few “grandfathered” exceptions, the Act didn’t allow policies not meeting certain minimum standards to remain in effect, and that is why premium increases and cancellations occurred.
The President has indicated that the Administration is willing to postpone this provision for one year for the benefit of about twelve million policyholders, letting them keep coverage greatly inferior to what the ACA would enable them to get, sometimes at a higher cost, (1) subject to their insurance companies agreeing to do so (insurance companies frequently change benefits and rates on these products anyway) and clearly advising policyholders of exactly what their policies will not cover, as well as (2) the concurrence of the state insurance departments which regulate such policies.  Doing so, unfortunately, opens the door to other changes and the Republicans in Congress are poised to crowd through that door with more changes.

When the President initially said that individuals would be allowed to keep their policies, he ought to have gone on to say that they could do so if the policies were at least as good as what would be available to them through the Affordable Care Act.  He didn’t add that those with inferior, substandard, but cheaper policies, but who were not poor enough to qualify for Federal subsidies to purchase a better policy through the Act, would be faced with cancellation letters from their insurance companies because under the ACA, such bare-bones health insurance policies, the kind that provide inferior coverage and exclude a lot of things, would not be permitted.

Folks waiting in ER for care may actually have insurance, but high deductibles and exclusions may prevent them from going to see a physician independently.   The ACA remedies some of these practices.
This overlooked the fact that many people could not afford to purchase more than these inferior products in the first place and were content with them, particularly since “real” insurance at that time, as well as that now being made available via the ACA, would probably cost them more.  These policies’ high deductibles and limited benefits are wonderful so long as an insured remains healthy, but do a poor job when there are real bills to be paid.

Aside from the now-apparent difficulty in developing a technology capable of handling the Affordable Care Act in coordination with the other government systems and private insurance company systems connected to it, the Act seems to be faced with enormous challenges, one of which is informing the public of the many kinds of choices available to them from private companies and whom to contact to learn about them, since health insurance is not a product one buys online, despite the government’s misguided belief that it is.  It is clear to me that sooner or later, the Affordable Care Act will be replaced with a single payer system similar to traditional Medicare, which except for supplementary coverage to cover “gaps,” will treat everyone in the country equally and not involve private insurance companies. 
A radical idea?  No!  Even right wing seniors are satisfied with Medicare!

This is the way it works everywhere else in the world.  It would work well here too once we get over our infatuation with the private insurance company system for health insurance.  Until *then, we will have to try to make the Affordable Care Act, with all of its warts, work.  The number of uninsured people in our country and the number of bankruptcies caused by medical bills are proof enough that our present health care delivery system, the most expensive in the world, isn't working.

* then may be defined as that point in the future when there is a Democratic President in the White House, solid Democratic majorities in both the House and the Senate and a majority of Justices on the Supreme Court appointed by Democratic Presidents.

Jack Lippman 

Sid's Corner



Sid Bolotin

“Hey, Gramps, could you help me with my project? This is my last semester for getting my master’s degree in social work. The course is on death and dying, and I have to explore what people in hospice might talk about. I know that you volunteered at a hospice care center for a few years and talked with many patients. Could you share some of those conversations … not naming names, of course?”

I looked fondly at my granddaughter with awe at what path she had chosen for herself. She had been interning at a halfway house for single women and was now interning at a high school in Boston.

“Of course I can. The topics varied because they were free-form, and based on a patient’s age, degree of decline, and choice of subject. Do you require a particular scenario, or do I search my memory at random?”

“What ever comes to mind, gramps.”

“Well, one chap, Carl, comes quickly to mind because at the time he was eighty like I am now. He told me that more and more he was replaying events and feelings from his early life...going back sometimes to his infancy. He said that these reveries could be triggered by a book, a movie, or an experience that one of his progeny was going through.”

“Oh, that sounds perfect,” my granddaughter gushed. “What did he tell you?”

“What comes up immediately is his reading of a series of crime novels that featured a detective in the LAPD with whom he strongly identified because the author imbued the detective with attributes that resonated with Carl. Primarily, the persona of being a white knight bringing the bad guys to justice reminded him of his enchantment with the Lone Ranger and the Green Hornet whom he listened to on the radio long before television came to be a household fixture.
The Green Hornet and Kato bringing bad guys to justice
Furthermore the detective’s tortured childhood … father’s abandonment, prostitute mother murdered, foster care, and juvenile detention fanned the flames of Carl’s psyche. He even confided in me his memory of lying in his crib at three and vowing to gather an army of animals a la Tarzan of the Apes to seek out and punish all the bad people in the world.   

He also told me that he delighted in the author’s infusing his hero with an interest in the philosophical question of whether or not there is evil, the Darkness, in the world or just people doing evil deeds. Carl was avidly interested in philosophy and particularly enjoyed the dialogue created between the detective and other characters in the books.”

“Wow, that’s fabulous!” my granddaughter virtually shouted. “I love it! Are the other conversations like that?”

“No, my lovely one, they’re all over the map. Some focus on a patient’s wish to discuss the immediate experience of knowing that life is coming to an end as we know it…a tad heavier than what I just related. We can hold the heaviness for another time. Let’s see your professor’s reaction to Carl’s story.”   


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