Beyond the Cusp

May 11, 2017

Of Healthcare and Health Insurance

 

Obamacare was not about receiving healthcare but on how it was to be covered, how it would be paid for. Trumpcare is not about receiving healthcare but on how it is to be covered, how it will be paid for. So, nobody is going to die because they cannot receive treatment because of either legislation. The differences are all about how health insurance will be distributed, paid for and the role of government in this procedure. Another item which is required is the knowledge that there is no such thing as an untreatable patient because by regulations any hospital which receives any form of government money, Medicare, Medicaid, Veterans Reimbursements or direct government aid are required to treat absolutely anybody who comes to them for treatment regardless of whether or not they are capable of paying for the treatment. This includes treating the uninsured, the homeless, the indigent and anybody else who comes to them for care whether through emergency vehicle or simply walking in the front door or the side door marked “Emergency Room.” The hospital I used to work for as a Biomedical Engineering Electronics Technician, the Washington Hospital Center, a thousand bed cardiac care hospital which also has Washington D.C.’s award winning burn center, a top eye and ear clinic, a Cath Lab with a half dozen operating theaters including two Electrophysiology Labs, an EEG department, an entire separate Physical Therapy Hospital attached to them across the entranceway, two separate operating theaters, one with a dozen operating rooms and the outpatient theaters with five operating rooms, one of the areas major Trauma Centers with two medical helicopters and six bays of which two could be used for emergency surgeries, an entire series of outpatient health clinics covering everything from inoculations to chronic treatments plus much more, and was a hospital which provided close to two million dollars in free care back when I was an employee in the late 1980’s through the early 1990’s. So the untruth that people in the United States die on the street because they were unable to receive treatment anywhere because they had no insurance is exactly that, an untruth. In the United States all but a very small number of specialty hospitals and members’ only hospitals, which treat either certain religious groups or select people who belong and pay either a monthly or an annual fee, receive federal funds one way or another and thus are required to treat all who come to them needing treatment. That is the first point that needs to be told as it removes the largest complaint that people are falling dead all over the United States in nearly every city as they are denied treatment because they are uninsured. The claims that we would soon see carts dragged through poorer neighborhoods calling for them to bring out their dead (as seen below) were a bit of an over-exaggeration.

 

 

So, the two plans are all about health insurance, not healthcare. The next truth, which is being used to cast a false accusation, was that the large increases in premiums came since President Trump became President, thus are his fault. The quote that the largest and by far most drastic increases in insurance premiums have been witnessed this year is absolutely true. The claim this makes them President Trump’s responsibility is quasi-valid. That President Trump has caused these drastic increases is false. What is true but seldom mentioned is that all of the statutes and regulations derived from Obamacare came into effect this year as of January first. Now this could all be coincidence, but I doubt this. Many premiums had been seen to increase, in some states almost, if not, doubling, last year as another round of regulations, laws and rules came into effect, but those paled in comparison to those that struck this year. The real effects intended by Obamacare have begun to raise their ugly truths with states such as Iowa fearing the loss of the final insurers pulling from offering coverage in the near future. This was the plan, to so bankrupt the health insurers leading to a panic, which would make a single-payer government health insurance plan acceptable due to lack of alternatives. One by one states would be forced to join Federal Government health insurance. The end result was to be Government Healthcare simply because the insurers who had covered health expenses could no longer make a profit as with the rising premiums people either opted for the Federal coverage or simply ducked from having any coverage. This is what Trumpcare is attempting to prevent and the reason why putting something in place quickly is so important. Unfortunately that also might lead to putting forward a flawed plan which will require patches and modifications before it becomes workable and this would be interpreted as poor planning. Meanwhile, a case being brought before the Supreme Court that would make Obamacare subsidies be limited to those states running their own exchanges threatens to force Obamacare to actually operate as written and not as expanded through broadened but presumed illegal interpretation (see map below). Should this case win it could open the way for more cases of a similar vein leading to strictly limiting Obamacare to the language of the law.

 

States Where Supreme Court Could Make Obamacare Subsidies Disappear

 

Emergencies often lead to poorly thought through or otherwise incomplete plans being put into force requiring more attention and an ongoing policy, which causes other problems as changing rules leads to fearful reactions by the affected companies, in this case health insurers. This could in part be the reason for the initial failure of the first attempt at cobbling together a plan and that may prove to have been a saving grace. Now we have Republican Care II, which passed the House of Representatives but now faces review in the Senate where changes will very likely be made and then the legislation, and this is all we have, legislation, will be returned to the House of Representatives. There it may be changed further and this exchange will continue until something more complete and comprehensive which meets the principle concerns of the Senators and Representatives and then will be passed on to the President. This is all depending on one little technicality, the Senate Democrats. The Democrats have sufficient Senators to prevent anything being passed through the Senate through filibuster. The overt civility of the Senate has made the filibuster as simple as telling the President Pro Tempore that a filibuster is intended and the legislation is all too often tabled until sixty votes can be guaranteed to invoke cloture ending the filibuster. No longer does the Senate demand that Senators imposing the filibuster actually talk twenty-four hours a day seven days a week until they tire of doing so or cloture is voted. There was one recent exception when Republican Senator Ted Cruz of Texas read Dr. Seuss’s “Green Eggs And Ham” as part of his twenty-one hour solo filibuster before surrendering as none of his fellow Republicans stepped up to support his attempt at mainly a symbolic statement against Obamacare (seen below). So, out of courtesy, the Democrats will not be made to actually take to the floor and fill the time with endless driveling and possibly entertaining the media with the reading of children’s tales or misquotes. This is also why the filibuster is used so frequently in the Senate as it no longer requires any significant effort or contribution in support of the position taken by the filibuster in opposing legislation. This will also prevent the necessary back and forth between the House and Senate in the manner in which the Congress is supposed to function and also stall any possibility for relief from the impending disasters that will come as a result from Obamacare. This is one time where time actually is of the essence.

 

 

What is certain is that should too many insurers decide to no longer offer health insurance and simply close down this part of their companies, then there truly will be a healthcare crisis in the United States. Many will say that this would be a gift as it would usher in government provided healthcare at long last and the United States could joint the long list of civilized nations. These individuals and groups will leave out the interesting fact that most nations providing government healthcare have a different problem, they cannot provide for their own defense and rely completely on the United States to provide the deterrence, which keeps them safe, relatively and thus far. They will point to particular nations while avoiding numerous others to prove their point that government provided healthcare is completely doable. Those nations they refuse to point to are the reason it will not work in the United States as they found out in Britain when they finally decided that they had to cut back on the amount of healthcare they were providing while other nations approached their problems with price controls.

 

There is a light on the horizon, though most would never point to their success. There is one nation that has universal coverage, a very capable and viable defense force, and a form of government/private health insurance. That nation is Israel. They have a minimal coverage required be provided by all insurers for which each receives a government payout. Then the four insurance companies offer their base plans while the people pay a health tax to cover the base plans offered. Then each of the four insurers operates in areas they feel they can make a profit with at least two operating in each part of the country. Then each insurer offers additional coverages, which they give nice sounding names such as Silver, Gold, Platinum or Palladium, well, OK, not the last one as it is made up. Individual can take the base coverage or they can purchase additional coverages, which vary depending on which of the four companies they choose. This works well for the most part. Yes, there can be problems when a person’s coverage and their particular needs have a failure in coverage, but these are addressed individually. So, nothing is perfect, but it appears to work, at least as far as we have experienced. Where this system may not be perfect, it is a great starting point and with the numbers of insurers currently in the United States, some form of system like this should be capable of being established, perhaps one where the government simply dictates the medial price for the basic coverage and sets up variances for the different markets throughout the nation. That’s our best suggestion if the politicians in the United States are seeking a system that combines a set coverage for all, even to include major medical for unexpected emergencies and hospitalizations, combined with a competitive market where competition is used to reduce prices. In the meantime, let us wait and see what the Congress is capable of producing.

 

Beyond the Cusp

 

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