Falling through the cracks

As the Supreme Court draws closer to deciding the fate of the Affordable Care Act, and people either deride the act as Obamacare or draw blanks on its oft-confusing language, those of us in the individual market continue to endure gigantic increases in our premiums even while listening to people complain that they don't want the government to come between me and my doctor. I'm as disappointed as the next person in the healthcare act, insofar as it made deep compromises with the insurance industry and didn't go far enough to ensure healthcare equality. I believe in universal healthcare coverage, however flawed, but I know this will never happen in our country given the current political climate and the level of ignorance we see every day. I have resigned myself to paying for 15% plus increases in Sophie's healthcare coverage every six months to a year (over 150% increase in the last three years). I have researched and done due diligence, deciding to downgrade the boys', The Husband's and my coverage to catastrophic coverage, still expensive and ever-rising as well. I'll continue to grit my teeth in resentment toward those who believe the United States has the best healthcare system in the world and hatred toward those who support the insurance industry in any way.

When I publish this post, I'll call Anthem Blue Cross and begin another fight with them over coverage of Sophie's medication. I won't bore you with the details, but a drug that she's been on for years, that we got from Canada through a pharmacy in New York was just approved for use in the United States by the FDA. I am now able to get the drug at our local pharmacy through insurance. Unfortunately, even with insurance, the drug costs three times as much as it did when I bought it from Canada. That's just messed up and indicative of the bullshit that is the insurance industry, the pharmaceutical companies and American healthcare, in any form.

Here's an excerpt from economist Paul Krugman's column in today's New York Times:


To understand the lies, you first have to understand the truth. How would ObamaRomneycare change American health care? 

For most people the answer is, not at all. In particular, those receiving good health benefits from employers would keep them. The act is aimed, instead, at Americans who fall through the cracks, either going without coverage or relying on the miserably malfunctioning individual, “non-group” insurance market.

The fact is that individual health insurance, as currently constituted, just doesn’t work. If insurers are left free to deny coverage at will — as they are in, say, California — they offer cheap policies to the young and healthy (and try to yank coverage if you get sick) but refuse to cover anyone likely to need expensive care. Yet simply requiring that insurers cover people with pre-existing conditions, as in New York, doesn’t work either: premiums are sky-high because only the sick buy insurance.

The solution — originally proposed, believe it or not, by analysts at the ultra-right-wing Heritage Foundation — is a three-legged stool of regulation and subsidies. As in New York, insurers are required to cover everyone; in return, everyone is required to buy insurance, so that healthy as well as sick people are in the risk pool. Finally, subsidies make those mandated insurance purchases affordable for lower-income families.

Can such a system work? It’s already working! Massachusetts enacted a very similar reform six years ago — yes, while Mitt Romney was governor. Jonathan Gruber of the Massachusetts Institute of Technology, who played a key role in developing both the local and the national reforms (and has published an illustrated guide to reform) has surveyed the results — and finds that Romneycare is working pretty much as advertised. The number of people without insurance has dropped sharply, the quality of care hasn’t suffered, and the program’s cost has been very close to initial projections.