The days before Christmas should have something to do with the euphoric torment of hunting down gift ideas, emptying bank accounts for said gift ideas, hopping from one holiday gaiety after another and watching the scale wipe out whatever gains we pretend to have made over the previous 11 months of gluttony.
We do some of that in our household. But for us as for the millions of Americans who don’t get their health insurance from their employer or from the government, the Advent calendar is the annual calvary through open enrollment. We spend weeks making actuarial bets on our health and looking for the insurance plan least likely to bankrupt us while still providing us some access to what only people with acute psychosis still refer to as the best health care system in the world.
Obamacare should have made all that unnecessary. But Obamacare was born with a fatal defect: its main driver is private insurers. That’s like building a cancer treatment center on top of a nuclear waste dump. To insurers, Obamacare is legalized extortion from policyholders and from the government, in exchange for as little coverage as they can get away with. It’s been an orgy of record profits comparable only to oil companies’ shakedown.
Add to that Obamacare’s decade of deaths by a thousand lawsuits filed by Republicans who can’t stand those subsidies or mandates requiring insurers to cover preventive care or forbidding them from denying coverage to people with pre-existing conditions, and you’re left with a maze of chutes and ladders that require a full-time cryptographer to navigate.
Here’s a diseased little factoid you’re probably not aware of, especially if you get your insurance from your employer: this year the government’s subsidies for private employers’ health insurance–$345 billion— is almost five times the subsidy –$71 billion–going to people enrolled in Obamacare. Dollar for dollar, individuals in Obamacare still get more. But why are employers subsidized in the first place? It’s a massive cost-shift to government and yet another shoveling of dollars to insurers that pushes up the price of health care even as we continue to pretend it’s just employee-provided.
I should note that my wife is among the 49 percent of Americans who get insurance through their workplace. In most ways but one it’s great insurance worthy of ululations. Hardly any deductibles or out of pocket expenses. No premiums. But she can’t choose her doctors. She can’t even shop around. It’s Florida Healthcare or pay them yourself. That’s not a choice. It’s an edict forced by the insurer. But “choosing your own doctor” is one of the big myths of American healthcare. Except for Medicare recipients and the wealthiest few, no one gets to choose. For most, the insurance company is chosen for you, and the insurer, in turn, hands you its list of approved providers.
Beyond that, you’re out of luck, which puts the lie to one of the principles of modern American healthcare: providers justify high premiums and out-of-pocket costs on the assumption that you’ll spend less of your own money on wasted services than if you had full coverage. You’ll shop around, get the best deal. But there is no shopping around allowed.
And the very notion of shopping around for care like it’s melons and soy milk is absurd–or immoral–when you’re faced with life-changing shocks to the system. (Excuse me, left anterior descending artery, let me do a little internet research on the best doc deal in the tri-county region first before you continue to kill me with this myocardial infarction.)
So when my wife got a new job this year and left the healthcare marketplace, she had to sever the relationships she’s had over years with her previous doctors, and–like me, as a casualty of cancer–make all sorts of gambles she shouldn’t have to make on the kind of care she’ll receive.
Adding me and my son to her plan is an option, but we’d have to pay over $14,000 a year in premiums. So it’s not a real option. Back to the marketplace, where I’ve been paying “only” $11,000 this year. But here’s the catch. If I wanted to keep the plan I’m on now, it’s increasing 33 percent to $14,000, with an $8,000 deductible, and with additional co-pays. I have the option for a plan of just under $10,000, but the deductible is more than the cost of a new car, and of course forget about choice in doctors.
What if I get cancer again? The plan I’m looking at would leave me with a $20,000 bill after my first week of radiation, assuming I’ve not been condemned to the walking dead just yet. If I paid for a lower deductible, my premiums would nearly double. But if I do that and don’t get cancer, the money would be wasted. Maybe I should get cancer again or some catastrophic illness. At least I’d get my money’s worth.
That’s the perversion of our healthcare system. Stay healthy, and it’s tens of thousands of dollars out the window for nothing. Get sick while you haven’t made the right gamble, and you’re getting bankrupted anyway. That’s why 100 million Americans have health care debt. That’s why we have the costliest health care system of any industrial country, and by far the worst health outcomes–the lowest life expectancy, the most diseased population, the cheapest government and the cruelest marketplace.
The 60 million people on Medicare are luckier. They get to benefit from European-style universal government insurance combined with private providers, giving them an almost unlimited choice of doctors, clinics and hospitals. If they want supplemental insurance, they’re free to have that, too. It’s nowhere near perfect. But compared to the rest of what most Americans are saddled with, it’s rapture: at least you get to be in agony with peace of mind.
The same model should apply to all, from birth to death. But two constituencies stand in the way: insurance companies, which stand to lose some of their obscene windfalls, and Medicare recipients, who skew Republican, vote in higher proportion than younger blocks, and carry the day against expansion. They’re the ones who should be marching to the Capitol, demanding Medicare for all, looking out for their children and grandchildren. Instead, they’re at Margaritaville, or at Mayo Clinic, lecturing the schmucks slaving for them about the virtues of Darwinism.
Pierre Tristam is FlaglerLive’s editor. A version of this piece airs on WNZF.