The reality of healthcare is this: if we Americans wanted just one thing – access to health insurance (and therefore healthcare) without denial for pre-existing conditions – the reality is that would require regulation, government mandates, a mix of incentives and subsidies, and a policy that might make some insurance companies choose not to participate.
…which is basically what the Affordable Care Act did, but for several issues that were preventing Americans from getting not just affordable coverage, but treatment that wouldn’t bankrupt them.
The other thought I had this morning, was also related to very simple basic math, and the way things work: let’s say we do remove government “interference” from any and all private insurance. What would that produce? Actually, what DID that produce? Anyone remember HMOs (which generally only reimburse doctors and hospitals 10% of their costs)? Anyone forgotten how insurance company sought to do what completely unregulated businesses can do – which was to minimize expenses (not paying patient claims, denying care to anyone who might have an obvious illness or pre-existing condition, incorporating and establishing insurance plans in states with little or no regulation – thereby making it possible for them to simple avoid legal claims when they didn’t actually cover what their customers’ plans supposedly included)? Well, most of us do remember.
Also, this talk by some about how we shouldn’t be forced to pay for someone else’s insurance… Again, removing all government, you do realize that’s currently how insurance does in fact work, right? Even if you’ve never had a health crisis, you are in fact paying part of your premiums to cover health costs for another group that will. And that’s where the situation gets interesting… Insurance companies want to maximize profit and reduce expenses. And they increasingly try doing this by reducing and separating as many of the healthiest people possible from everyone else – making everyone else costs skyrocket beyond their ability to pay (effectively making any healthcare for them nearly impossible, or potentially causing them financial ruin), while the supposedly healthier remainder still has to deal with the other insurance company issues: they don’t even want to pay your claims, should you ever have them.
The ACA was an attempt to address these issues. And, if you really want to address these issues, the ACA provided the best private business + government regulatory solution possible. You can’t have a pre-existing condition “opt-in” for states, because the simple math already tells us what will happen – anyone who’s ever been sick with any serious before, will be priced out of the private market, if there are no minimum standards required and enforced by the government.
So, the question really is, do you only want to pay for your own health? If so, here’s what will eventually happen under unregulated private insurance: roughly 5% of you will have access to a relatively cheap couple of plans, which make you feel good about how you stuck it to the big bad government. A majority of people will be priced out – unable to afford the costs. The remaining small group who needs insurance and healthcare and is just earning enough to cover their higher premiums will do so out of absolute necessity – which means most of their income after mortgage and food will be consumed by insurance, instead of going back in to our consumer economy.
But most importantly, to those very few people who have affordable access to healthcare designed specifically for them (younger people with no detectible or pre-existing health issues), just wait until you get sick. That’s when the private insurance system you wanted so badly, will turn on you. They’ll either not pay your medical bills outright, or they’ll remind you of some fine print clause that allows them to avoid paying your claims, or they’ll find something in your medical history that justifies their denying your claims (up until 2014, they had thousands of employees dedicated solely to this type of work).
And after that, you’ll be forced into the “high risk” (and significantly higher priced) pool.
So, the attempt to solve all of these issues wasn’t some pinko-commie conspiracy to kill freedom. It was literally the most basic math and oversight necessary to actually solving the problem.
The saddest thing about this whole issue is that it has become so politicized, that regular people can’t even discuss the reality without supercharged rhetoric.
Sadder still, watching the majority party having spun themselves into a corner from which the only way out will be to remove all the things that actually make any public policy work.