One of the most difficult choices for individuals during benefits season is trying to “anticipate” their medical needs through the year in order to purchase health insurance. This is harder as health insurance covers less and-or for more money.
The government got a taste of its own medicine with the Ebola situation and serves as the strongest argument against Obamacare’s emphasis on mandating some insurance as better than none, a hyper-focus on prevention rather than protection for treating illness in terms of health insurance by providing for check-ups as part of qualified health plans often with sacrifices of increased costs for treatments in the form of higher co-payments, deductibles, and co-insurance and the experience already that thinner participating provider choices (meaning fewer) makes it so that people who become ill will have fewer choices of who or where they will be treated.
As in the case of Ebola, Obamacare will like prove an illusory protection from the physical and financial devastation of illness if people actually become sick and need more than reassurance that their health insurance is good enough.
So, what are we to do? What should the government have done differently?
For consumers, Ebola highlights that our country was ill-prepared for the TWO Ebola cases that we’ve experienced.
Even some Democrats have gone beyond the President’s silky words that all is well and are finally supporting change, such as Democrats advocating SOME sort of travel restrictions. (For instance, on 10/21/ 2014, Russell Berman reported for, “The Atlantic,” that “Democrats Defy Obama in Favor of an Ebola Travel Ban,” http://www.theatlantic.com/politics/archive/2014/10/democrats-defy-obama-in-favor-of-ebola-travel-ban/381712/.
First question for consumers: Is what we're being told matching with what we're seeing happen? Obamacare highlighted the what we thought-what it is dichotomy. Logic should come into this as well.
If you choose a catastrophic plan you will satisfy the President because you will have bought insurance and will be added to the tally of “THE INSURED” while avoiding the individual mandate penalty for not having insurance.
However, catastrophic plans available only to those under 30 or those who obtain a “hardship exemption” will likely leave you in financial ruin if you get sick. (See healthcare.gov, catastrophic health plan).
Just like our nation's Ebola plan. Sure, the US has biocontainment units. Sounds good. But, as we learned with the challenge of handling merely TWO cases, coverage was largely illusory.
How do we know? Because we’ve heard that of the 19 available beds throughout the US, some of those beds are not available because there is no staff to manage patients in those beds, procedures were inadequate, equipment is inadequate and American taxpayers have watched our expenses for everything from purchasing and training personnel to Congressional hearings involving individuals whose salaries we pay chewing away at our tax dollars.
There are more questions that arise for us during this benefits season that follow from having learned of the “illusion” of Ebola capability (illusion based on the fact that two cases could not be handled without additional worry, without additional money and without additional policy).
Our second question when considering our health insurance: Is our coverage illusory? Will it require far more money to pay to regain our health in the event of illness than we anticipate? The answer is arguably, YES, on both counts.
Obamacare supporters know that Obamacare does not address many of the reasons that 47 million Americans entered the ranks of the uninsured. That’s why the individual mandate was included to begin with, to address the choice made by millions of individuals who decided that health insurance was not worth it. So, to pursue an elitist and oft-ill-informed political agenda, we were sold Obamacare which includes the most illusory choice of all, the catastrophic plan.
If you get sick and have a catastrophic plan which is ineligible for Obamabucks the Federal contribution towards premiums thus reducing your out-of-pocket for PREMIUMS, you pay for PREMIUMS.
Then if you get sick you have to meet typically a higher deductible. The maximum deductible, how much money an individual or family would have to pay for healthcare before reaching the maximum for the year for individuals and families is set to go up in 2015 ($6,450 for self-only coverage and $12,900 for families, up $100 and $200 respectively, http://www.bcbsm.com/content/microsites/health-care-reform/en/reform-alerts/irs-provides-guidance-on-2015-high-deductible-health-plans.html).
Unlike the Federal government which uses us as its wallet, we do not have access to endless funds, especially if we’ve chosen a catastrophic plan which typically attracts those with fewer financial resources. So, we don’t get to pick up the pieces by spending other people’s money in order to fill in the holes in our coverage, unlike the Federal government.
Are we better off that the US had some beds that they’d maintained for years JUST IN CASE of an outbreak, or would we have been better off waiting for an outbreak and THEN doing what we’ve done, obtain supplies, staff beds, have Congressional hearings and await CDC protocol establishment which we ended up having to do anyway? The answer is less about the clown rodeo of Federal conduct and more about our choices.
The third question for consumers is, “If you don’t have an illness how much coverage should you buy just in case?” This is a decision each individual wrestles with, but as insurance costs rise, coverage of illness diminishes in terms of choice and insurance company contribution to costs goes down, those who argue “Wait till you get sick,” seem less irresponsible than ever before.
A few other features of Obamacare that make the catastrophic plan (if you’re under 30 or have a hardship exemption) and the bronze plan less unattractive are the fact that most higher-coverage plans have also raised deductibles and co-payment and co-insurance contributions, the out-of-pocket cash expenses for their plan members. As these plans flirt ever-more-closely with the least coverage, reconsideration each year of the sense it makes to purchase a particular plan is important.
The Federal government and its 11-bed scenario (10/18/14, CNNHealth, “What's more contagious than Ebola in the U.S.? Concern about its spread,” by Holly an, Kyung Lah and Gary Tuchman, http://www.cnn.com/2014/10/15/health/ebola-fears/index.html) surely describes the case of false confidence in illusory capability. Our preparedness was not good though we had “some” policy, “some beds,” “some staff” and “some protocol.” This is Obamacare in a nutshell and brings us to our next step, when we look to needed change, the Ebola scenario IS relevant and any candidate who treats Obamacare as a done deal does not deserve a vote.
Our fourth question: Is crappy coverage better than none? (Naturally law requires you have some coverage, but this is relevant in terms of POLICY)
Our fourth question is whether a pathological focus on prevention is worth the sacrifice of meaningful reductions in the money sick consumers must pay to regain or maintain health? Obamacare increases the costs for consumers for most medical care and services for illness through the trend of “individual responsibility” emphasis focusing on increased contributions of dollars by consumers for their own care via higher deductibles, co-payments and co-insurance).
Further, by forcing preventive screenings to be “included,” insurance companies have been very up-front that they’ve taken away from other coverages to comply with the Federal law. Further, once insurance “covers” something, like preventive screenings, the marketplace typically responds with loads of people providing those services and making money off easy and often higher payments for such services. Far from putting LIMITS on what we’re charged, Obamacare therefore supports HIGHER prices so that the cost of screenings will likely increase overall and significantly as providers see the cash-cow of insurance payments. Already in many places individuals can no longer get inexpensive physicals or affordable screenings if they’re paying cash.
The so-called “free” preventive care services are designed to allow consumers at no additional cash outlay to find out whether they’re sick earlier thereby increasing health and reducing the costs of treating illness. Nice theory but Obamacare does not support that outcome overall.
Since only very basic screenings are covered, if something is found that needs further attention, consumers are actually paying more because of increased co-payments, co-insurance and higher deductibles. In other words, free screenings only work in terms of money if you get good news from your screening eg if you’re well.
If you have an issue, under Obamacare the free screenings which have been balanced by insurance companies with provisions charging consumers more for actual medical services actually have saved you nothing. The increased amounts individuals will pay for actual treatment and care will also likely discourage individuals from getting some of those “free” checkups. And remember, defensive medicine, the practice of testing and testing and testing at the cash expense of the consumer, also not addressed by Obamacare.
Our biggest failure in terms of Ebola policy and in terms of Obamacare is to recognize that regardless of whom we want to blame, whether it’s individuals for making bad choices, or in the case of Ebola, nurses for following inadequate protocols in the case of Ebola, prevention doesn’t always work.
The government knows this as we see Obama’s push to eradicate Ebola in Africa COMBINED with spending, staffing and preparing for treatment in the US. But in our case, prevention is used as an EXCUSE to provide fewer and more expensive options to people who are not successfully “prevented.”
Obamacare has required preventive services for “free” though naturally they’re not for “free” since we’re being charged more and facing other cutbacks in the face of insurance companies who justify providing less BECAUSE of their preventive coverage.
This is a huge risk. Prevention doesn’t always work and Obamacare which has incentivized insurance companies to RAISE insurance costs because of inclusion of preventive services which will in turn raise the overall going rate charged by those providing preventive services who can now count on insurance company coverage AND will reduce coverage if people get sick jeopardizes rather than supports health.
Ebola has highlighted some of the flaws of ILLUSORY coverage. Our entire country has been thrown into a frenzy because of TWO cases of Ebola that have highlighted our lack of preparedness.
No matter how many self-congratulations and explanations and opinions we get the inescapable conclusion is that what we did have in place in terms of Ebola preparedness was for the most part an illusory sense of security that was only good until we needed the coverage for Ebola. Our goal as consumers is to address these same problems with the policies, procedures, and gobbledygook of the Patient Protection and Affordable Care Act.
We must address and reconsider the bottom-heavy focus on “free” prevention which as is written in Obamacare now only works financially and physically for individuals who get a good result from their checkups (who never test their illusory coverage).
We must work to lower the out-of-pocket expenses that consumers are responsible for rather than continue to raise our financial vulnerability in terms of higher premiums, higher deductibles, higher co-payments and higher out-of-pocket maximums which will leave MORE rather than fewer Americans at risk of financial ruin in the event of illness.
We must work to make sure that networks of providers are sufficient to satisfy the needs of consumers.
We must reconsider essential health benefits that require men to pay for maternity coverage, single people to pay for children’s dental and vision care or male victims of domestic violence to pay for counseling for female victims of domestic violence while having no coverage included for them.
These are just a few of the steps that we must consider taking to make Obamacare more than another Presidential brag of how great something is that is not great at all but illusory.
