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Tuesday, February 25, 2014

Quit Shooting the Messenger Just Because He Brings You Bad News

Or, Why You Should Be Pissed Off At Your Insurance Company Instead of the ACA.

As every "Obamacare Horror Story" Fox Noise uses to try and make "fetch" happen gets picked apart with pesky facts and omitted relevant details -- the bane of every Fox story -- it's becoming apparent that the ACA is not our enemy, here.  The law is simply a convenient scapegoat for the real reason people are angry.

What the law has uncovered is the systematic fleecing of the American populace by the insurance industry itself.  And the ACA uncovered this because it's these dishonest, terrible, expensive practices that the law was written to eliminate.

The most frequent "horror story" we hear on the Scared Old White People Channel is that some poor sod's insurance company canceled their policy for ACA noncompliance, or switched them to a compliant plan with a ridiculously higher premium.  The reason every single one of these stories falls apart under even mild scrutiny is twofold: 1) Fox and other right-wing propaganda outlets purposely do not explain what a "non-compliant" insurance policy means in practice, and 2) these same outlets purposely omit any information regarding subsidies for insurance premiums.  Thus making it seem like the ACA is costing the consumer more money, when in reality it's saving the consumer from being ripped off.

See, before the ACA, there was no minimum standard when it came to health insurance policies.  A policy could quite literally cover/not cover anything.  And that "anything" was solely up to the company's discretion.  As a result, many of the plans in the individual market were actually worse than having no coverage at all.  Because at least if you don't have insurance, you aren't paying a premium.  Many of these plans didn't cover doctor visits of any kind, and deductibles ran into five-digit figures for individuals.

I should know.  I had one of these terrible plans back in 2008-2009 when I was working at a call center because it was the only one I could afford.  My premium was around $80 per month, and the policy didn't cover anything unless I was treated through the ER or urgent care.  And even then, the ER was a $100 copay, and for urgent care, $50.  And it didn't cover prescriptions, either.  Nor did it cover anything if your injuries or condition were self-inflicted (so, you know, if you were going to attempt suicide like I wanted to do so many times, you better make damn sure you succeeded).

Bottom line was that even though I had insurance, I was still fucked sideways with a chainsaw anyway if I was unlucky enough to need medical care.

What the ACA has done is made these terrible policies illegal by setting a minimum standard for what insurance companies need to cover.  Hospital visits, emergency services, doctor's visits, prescriptions, mental health, maternity care/reproductive health, outpatient, preventive care, lab services, rehabilitative care, and pediatrics are all mandated coverage.  Before the ACA, these were "Cadillac" services.  Stuff you had to pay through the nose for with a blood sacrifice and half your soul.  Now, they must be built into every policy.

What this means for you is that the ACA is forcing insurance companies to actually cover you instead of taking your premium and laughing at you when you need treatment.  Especially for pre-existing conditions.

What this also means, of course, is that the $80-a-month-for-nothing policy will have to become a $250+-a-month-for-real-care policy.  And that is where the other pesky detail that Fox wishes would go away comes in: the federal subsidy program for the middle class.

See, based on your yearly income and the state you live in, you may qualify for a subsidy toward your insurance premium.  Meaning that the federal government foots part of the bill so that you can buy the insurance you need.

In many of these "horror stories" touted by the right, the "victim" didn't even go to Healthcare.gov to shop for a new policy or apply for a subsidy; they simply took whatever their current insurance carrier offered them (you would think the ideologues who worship Ayn Rand's fossilized feces would realize that the "free market" can't work if people don't shop around for the best deal they can get, but since when has the team at Fox let logic get in the away of bashing a black guy?).

For an idea of how this works outside of Republican Tea Party Fantasy Island, I went to Healthcare.gov myself for a look around.  First thing I will say is that I'm probably making less money than a lot of people reading this.  Before taxes, I bring in about $16,000/year, and I live in Florida (a state that refused to expand Medicaid, but that's another rant entirely).  Silver plans (which are the minimum I would need) for me would run about $230-$290 a month regular price.  But because of my income, I qualify for subsidies that bring that cost down to $50-$65 depending on the policy.

This means I'm getting comprehensive coverage for less than what I was paying for the plan I had before that was so shitty it's illegal now.

Blaming the ACA for increased premiums and canceled policies is a bit like blaming Watergate on the security guard.  The problem is that we've grown so used to a broken healthcare system run by professional crooks that when someone finally tries to fix it, it's easier to get mad at them for having to rip apart the wall than to get mad at the roaches they're trying to exterminate.

And right-wing blowhards are all too ready to take advantage of that complacency if it pleases and lines the pockets of their corporate masters (many of whom are insurance companies, to the surprise of absolutely no one).

See, unless you are independently wealthy and can afford to pay out of pocket, someone else is going to have to pay for any medical care you receive.  And if you can afford out of pocket costs, you are paying for a bunch of other people's care whether you want to or not.  So the Ayn Rand argument is kind of moot because if you can pay, you're already shouldering the cost of those who can't.  That's why saline IV bags that cost the hospital $1 end up being $90+ when the patient gets the bill. Under the ACA, requiring that everyone who can afford insurance buy some or pay a fee makes that system a little more efficient and less costly by spreading the burden of risk to as many people as possible who can afford to pay it (which, if you didn't know, is how insurance works).  The ACA isn't perfect by any means.  But it's a start.  It's something that can be tweaked and improved, and in some states it's already gotten people talking about a move to single-payer.  Something that, I might add, the rest of the world already has.

When it comes to healthcare, we're one of the most backward nations in the world, for one very simple reason: in places that are not the United States, being able to see a doctor and not come away broke is considered a basic human right. Here, it's as much a privilege as caviar and edible gold flakes.  When some of the poorest nations on earth have excellent universal healthcare, it becomes apparent that America's problem is not that we can't provide everyone in the country with the health services they need, it's that we won't.

Because the only thing America is truly exceptional at is pure, unfettered greed.