America's Health Care Identity Crisis

About every July 4th or after a presidential election writers try to explain the American Identity. Some of them, especially of late, conclude that the American Identity is in crises. America does not know who she is. Others say America knows who she is—she is freedom of speech, religion, and opportunity. America is individualism. If there is an American Identity crisis, it is because we have replaced these freedoms with government interference.

There's no denying American democracy is under attack, but ironically our present debilitating state has crystallized our identity. As the famous quote by Carl Jung, "you are what you do, not what you say you'll do." America is and has always been what it does, not what it says.

America is a place where:

  • Slumlords rent substandard, barely habitable housing to the poor because people will pay to live there
  • Payday lenders, check-cashing centers and prepaid debit card providers keep the working poor in a cycle of debt offering services traditional banks will not
  • Children, under strict rules, receive summer meals from food trucks
  • Families wait days to receive free dental care at tent clinics where buckets of pulled teeth pile up
  • Hospitals charge the poor and uninsured full price for the same medical care the rich and insured receive at a steep discount
  • A cancer-stricken Senator who's been on the receiving but never the giving end of compassion, votes to put in motion a vote that will make health care more expensive for the poor, sick and elderly
And yes America is still a preferable place to live than just about any other country in the world. We still have a far superior economic and political system than most. But that is why conservative efforts to leave the poor at the mercy of health insurance companies and so-called free-market health care are so frustrating.

Avik Roy, Paul Ryan, Mike Pence, Tom Price and other conservatives talk about the freedom people will have to buy only the health insurance they can afford even if it's crappy coverage. That's the equivalent of saying that it is okay for families to pay rent at market rates for a house without a working toilet, broken windows and holes in the walls. These guys use the traditional definition of American Identity, freedom, to justify withholding legitimate government services and investment in its citizens.


Why doesn't America cringe at the thought of buckets full of rotten teeth and decide that's not what America is? Why doesn't America say that even though there is a market for a specific service, we won't let the lucky take advantage of the unlucky? Why isn't America ashamed that it believes more in the principle of freedom to die prematurely than providing basic health care to everyone?

America talks a good talk about democracy and freedom, but the world sees all the bad stuff too. They see the wretched conditions of America's poor communities. They see poverty, gun violence and a country unwilling to solve its health care access and cost problems. They see America for what it does, not what it says.
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The Health Care Reform Fight Is Just Beginning For Some Of Us

While the health care reform debate stalls in the Republican-majority Senate, individuals health insurance purchasers like me are left wondering what's next. Will Health and Human Services Secretary (HHS), Tom Price, miraculously develop a base level of professionalism and sense of duty to administer the Affordable Care Act (aka, Obamacare), the law of the land, for now, the way it was intended? Will Republicans restore the funds for the risk corridors so that insurers are certain that the government will cover losses they may incur? Will HHS role out a robust national open enrollment program for the exchanges and will they staff the effort appropriately? Or will the Senate, like the House, find a way to pass their awful health care bill, the Better Care Reconciliation Act (BCRA) before the 2018 Open Enrollment on the Exchanges?

We, I, need answers to these questions soon because the fall health plan open enrollment season is just a few months away. My current health insurer has already sent me a good luck because we won't be here for you next year letter. And health insurance companies need answers to these questions now to make decisions about what, if any, plans they will offer to individual health plan purchasers.

Reason To Be Afraid For The Future Of Individual Health Plans

It's so disheartening to witness long-term Republican lawmakers and the White House react so vindictively to their current legislative debacle. After seven years of ranting about the awfulness of Obamacare and promising a better replacement, they delivered bupkis. But don't expect these guys to hang their heads in shame, that's a completely unfamiliar emotion to them. In fact, they can't even call their failure a failure. This is
a line from the official statement put out by the Majority Leader's office on the Obamacare repeal vote.

" Regretfully, it is now apparent that the effort to repeal and replace the failure of Obamacare will not be successful."

In other words, Obamacare, which provided health insurance and health care to millions of people, is a failure but the seven-year long Republican effort that created the unpassable Trumpcare is not. The fact that McConnell refuses to acknowledge that Republicans do not have a better alternative to Obamacare that they are all willing to vote for makes me queasy.

And what's even scarier about the future of the individual health insurance market is that where McConnell leaves off in his hypocrisy and projection, Trump picks up with his mean, hateful, nastiness. Since being elected, (gag)
Trump has boasted about letting 'Obamacare explode,’ ‘die on its own,’ or ‘fail,’ as he and his fellow Republican liars and obstructionists do everything they can to undermine the law. He threatened explosion when the House wavered in passing their crappy health care reform bill, the American Health Care Act (AHCA); and now he's threatening the same thing now that the Senate's bill is down and out (for now). I think Trump is dumb enough to try this strategy, and with his devil's helper, HHS Secretary Tom Price, things could spiral out of control quickly for people like me. Continue Reading...


If Only Conservatives Would Demonize Health Care Prices Instead Of The Poor

Republican Congressman Mo Brooks of Alabama wants us to "take into account our financial limitations" in providing health care to every American. Some people interpreted his remarks as meaning that we can't afford to provide health care to every American. I want to give Congressman Brooks the benefit of the doubt and assume he meant that not everyone could have unlimited medical care at any price paid for by the government. But I can understand how others would translate his words negatively. Brooks is the same guy who talked about "people who lead good lives" as part of the health care reform debate.

This healthy people lead good lives, sick people lead bad lives is just updated phraseology for the same old moralizing nonsense conservatives use to demonize the poor and revere the rich. This type of thinking is so stupid and inapplicable in the real world. There are millions of healthy people who lead good lives that get sick. My best friend in the world was one of those people. She was active, did yoga regularly, ate organic, had an active social life and had a sharp mind. But one day she was diagnosed with cancer, and I lost her. This is a story repeated many times every day yet we still have jerks like Brooks that would rather use hateful language against the poor than address the unnecessarily high prices charged by hospitals and medical care providers.

You see politicians and doctors want us to believe the problem of unaffordable health care is our fault. If we only lead good, healthy lives, no one would need expensive, government-paid health care, says the politician. If we engaged in healthy behaviors and avoided unhealthy behaviors, we wouldn't suffer from expensive chronic diseases, says the doctor. And these politicians and doctors may have valid points—health care would be less expensive if we all lead healthy lives. But what world do these politicians and doctors live in? Who are these perfect, healthy people who do everything right in life? So instead of promoting this myth of the good, healthy, righteous, never need health care super-human being that does not exist, I wish Congressman Brooks and others like him would join us in the real world. A world where real good people, rich and poor alike get sick, sometimes really sick, and need expensive medical care.

The Alabama Congressman could address the financial limitations of high-cost medical innovations. About how much is too much medical innovation for the nation's pocketbook to cover? He could bring up for conversation why we require American doctors to obtain a Bachelor's degree before starting their medical degree education when many other industrialized nations do not. The cost of a medical education in America is the main justification doctors use for their high salaries. Mr. Brooks could learn more about the impact of socioeconomic factors on a person's health and support public policies to address these issues. He could also say that Americans should not pay
hundreds of thousands of dollars for heart attack treatment. But he doesn't focus on any of these issues. Continue Reading...


Now Is The Time To Start Talking About Health Care Rationing

We are right to mock the hypocrisy of elected Republican officials that criticize the Affordable Care Act (aka Obamacare) for leaving millions of individuals uninsured and doing little to address the high cost of health insurance. Instead of creating policies to address these two Obamacare shortcomings, Republicans decided to exacerbate them by withholding funding to insurance companies that all but ensure that premiums will rise even higher and fewer individuals will have health insurance. We are also right to sneer when conservative intellectuals and Libertarians extol the virtues of a so-called free-market health care system where people are free to buy or not to buy any level of health insurance, and from any location they want. When the reality is that health insurers aren't in the habit of offering a la carte health plans. There's also the issue of opaque pricing with “free market health care.” Another issue with conservative and Libertarian views on health care is that half of the purchasers can buy insurance at a significant discount because of the workplace health insurance premium tax exclusion and the other half have no such benefit.

But at some point, and I think the time is now, Obamacare supporters and proponents of single payer or universal health care will have to realistically and publicly address how their proposed policies will deal with the problems of health care costs and affordability. Unlimited health care at any cost paid for by the government is not a realistic option, and no such system exists anywhere in the world. There are and should be limits on the amount of medical care an individual receives if they are not paying for it or if doctors and hospitals determine additional care would have no meaningful impact.

Our current U.S. health care system already places limits on the amount and form of medical care individuals receive. Sometimes these decisions are based on ability to pay the cost of care, and at other times they are based on medical science. However, this approach of rationing medical care won't be sufficient in a Medicare For All style system. Rationing of medical care will have to be front, and center of any government paid health care system. But that is not to say that people will not have access to care the government won't pay for; they are free to purchase health insurance or health care individually.

Some people may believe that a government codified system of medical care rationing harms the poor and favors the rich. Not necessarily. First, the poor won't likely pay anything for their medical care, and they will have access to preventative and continuous care that should improve their health status. Second, the poor won't have to pay for costly medical innovations, one of the real drivers of outrageous U.S. health care costs, but they will benefit from them. And third, the stigma applied to government-provided health care is diminished and so is the incentive for doctors and hospitals to treat the poor differently.

Okay, But Not Now

Right now proponents of government-paid health care for all our engaged in a battle to keep the poor from losing access to medical care. They may feel that they have to accomplish this goal first before they can start the conversation about their ideal health care system. Meanwhile, opposers of government-based health care use the socialists, communists, and hippie-dippy, out-of-control spending argument to make universal coverage look less attractive than the status quo. And I fear they are winning this argument because of a weak counter-argument of a greedy, evil opposition.
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