Lot of talk about Obamacare this week, so i thought I’d give my rundown of what I used to tell my students.
Question 1 – Do you think if someone shows up at the emergency room, they should be treated, regardless of if they have money or insurance?
Some people might say “no” to this, and I will say that’s harsh, but ultimately logical in a Machiavellian way. However, as I was teaching bible classes, generally speaking my students would always say “yes, people who get hit by a bus should get treated.” And this is the law in the US in every state to my knowledge.
For me personally, this is the kind of country I would want to live in. So I’m in favor.
Question 2 – If they can’t pay, then what?
The money has to come from somewhere, and it’s true that hospitals will work with people to lower their payments, but the total is still due. There are a couple ways to do it:
A – The hospital raises ALL their prices, to offset the ones that can’t pay.
B – Non profits can donate to cover the shortfall
C – The govt can cover it either by direct payments or by tax writeoffs for the hospital. Either way, this is done with the taxes of EVERYBODY.
Question 3 – What is people choose to not have insurance, and then have an emergency?
You might see this often with young men. Generally speaking, young men utilize medical services the least. healthy, no pregnancies, and so forth. So, it was quite common for young men to just say “i won’t pay for insurance, and if i break my arm, i’ll just pay for it then.” Which is fine, unless you get shot. That costs a lot more than a broken arm, and we’re right back to question 2.
Obamacare
President Obama (or his staff anyway) said “It’s not right that some people just choose not to pay, and then still want society to pick them up if they actually need help.” So, Obamacare (the ACA) says “Everyone has to have insurance.” That way, everyone’s paying into the system, and you can’t just not pay and then expect everyone else to cover you. We all have to pay.
The problem is that insurance companies prior to the ACA would just insure healthy people. You couldn’t get it if you had recurring health issues, as diverse as tinnitus, cancer, or even pregnancy. That’s why your insurance cost $200 bucks a month.
Now, with the ACA, the insurance companies HAD to take everyone, including the really sick people. Which means the premiums went WAAAY up. Now it’s $1000 a month for the same insurance.
FINANCIAL FOUNDATION
Now that’s where most conservatives stop. They say “look what a disaster, the prices went sky-high. ” Yes, they did, and the people who set it up, including the conservatives at the time, already KNEW that. they’re not idiots.
Ok, but what if you can’t afford it? That’s where the health marketplace came in. You could shop for insurance, and the government would give you assistance to make up the short fall, based on your income.
So, let’s say you make $50,000 a year. You insurance goes from $200 a month to $1000 a month. BUT you get $850 a month from the subsidies to make up the difference. You’re actually further ahead, even though your insurance costs more.
(which is why i always thought it was dumb when people complained about how high their insurance was, but didn’t use the marketplace. Use the system, people.)
That was the idea of the ACA. EVERYONE is covered. EVERYONE pays. EVERYONE gets help if they need it. EVERYONE pays in.
Now comes the problem
But the Republicans in the senate at the time cut the part of the ACA that said EVERYONE had to have insurance. The problem is, that’s how it would get paid for. That’s why all those healthy people, who may never use insurance, had to pay. We all did, just in case they hit the unlucky jackpot one day.
So, all the healthy people just decided not to join, or joined “health sharing” sites for only healthy people. It kept their costs down, but screwed everybody else. (one of the reasons i’m not a fan of those kinds of orgs).
So, prices went up, and the costs to cover it did not have the tax base it was designed for. And then the Republicans say “what a disaster.” I think it’s lame. If you have a better plan, bring it, but don’t gut one and then claim victory.
SUMMARY
So, if you just look at how much insurance has risen, i think it gives a false impression. Yes, it’s gone up, but the idea is that more people (something like 30 million) got covered when they couldn’t before. AND it’s more efficient this way than just having us all pay for emergency visits. AND it’s better for people to get seen earlier, rather than waiting for the ER.
However, this does not mean that I think the ACA is the best answer. I think it’s OK, but what I would like is single payer. Essentially we get rid of insurance companies, and move that all to Medicare/medicaid for all.
If the Republicans today have a better plan, i’m open to it. I’d like the same questions answered as before:
1 – Do you think everyone should be covered?
2 – What happens if they show up at the ER and they aren’t?
3 – Who should pay for it if they do?
4 -How will you fund those payments?
I’m open to other options. I think the ACA is the best one we’ve implemented so far.
In any case, i don’t think it’s a “disaster.” If there’s a better plan, let’s see it and let’s try it. Just talking about how much the other one sucks, especially if you don’t have a workable other option, is just weak.