The Consumer Perpetrator Myth: Obamacare Failure 2016

There's a lot of misplaced sympathy out there--We felt the government's pain that it can't afford to be a contributing payer for people's health, either through entitlements of VA benefits, social security, Medicare or Medicaid. We felt the insurers pain that they can't stop raising their prices because of those damned people who actually have to use their financial product to help pay for the costs for needed medical expenses. We felt the pain of providers who explain that their "overhead" costs are simply too high for them to do anything but continue raising their prices.

As in every good fiction, there must be a clear villain, and in the case of our health crisis, it's the consumer. The damned human consumer daring to make unhealthy choices like eating fatty foods, or smoking, or inheriting bad genes, or aging, or…well, being human.

And since the consumer is the villain, who is the target for paying more, getting less, being forced to toe the perfectly healthy line? Yep, consumers.

It's the stupidest premise for our healthcare system that is codified by Obamacare, leaving those who paid into Medicare for their entire adult lives believing that THEY ARE THE DRAIN on our government's wallet, leaving those who are imperfect and eat fatty foods, have diabetes, smoke, drink, or merely age believing THEY ARE THE DRAIN on insurance company resources, leaving those whose health requires medical care for which providers charge sky's-the-limit prices believing THEY ARE THE REASON PROVIDERS HAVE BASICALLY A LICENSE TO PRINT MONEY. Yep, consumers, the CUSTOMER is the problem.

And so we embarked on REFORMING THE VILLAIN--the consumer. Penalties for failing to buy into expensive health insurance products we don't or didn't provide what we needed were "solved" by the Obamacare tag team of insurers and government--the government would FORCE us to purchase the consumer financial product of health insurance AND the insurance companies, now free from consumer pressure to make a consumer product that was useful for us (since we all HAVE TO buy their product) would instead focus on getting rid of those pesky people likeliest to use their product--the SICK, those in NEED of medical care, with a special penalty in the form of higher premiums for those damned smokers and those damned older people.

Providers meanwhile, who keep raising prices, even on the formerly affordable stuff like a camp checkup or blood tests, or aspirins, or any other of the new technologically possible tests that the government agreed to pay exorbitant prices for under the illusion that they would PREVENT ALL ILLNESS, jumped on the bandwagon--

The healthcare industry became an industry that more and more ONLY works for the healthy--they get free checkups, they get referred for test after test to make sure they're still healthy, they get complete coverage of those tests making sure they're still healthy and happily walked away deliberately unaware that IF for some reason they too were human, they too had health issues beyond the minor that they were facing government sanctioned higher payouts in the form of deductibles, copays and coinsurance combined with government determined higher out of pocket maximums, combined with fewer options for care under the minimum provider options codified by the federal government, combined with government counseling that pays providers to persuade their sickest patients that maybe going for a cure isn't worth it after all based on the costs.

Years in, in spite of growing evidence that perhaps focusing in on the CUSTOMER as the problem, there are still people feeling the pain of government, of providers, of insurers who have to deal with those damned sick people.

I never believed that the "solution" we'd accept to our healthcare crisis would become the LEGALIZED, legislated national commitment to pretending that health insurance is about education and checkups combined with punishing those who are not ideal specimens either because of their habits, their genes or their age while as a population we DEFENDED the government that cannibalized our tax dollars while preserving superior insurance for themselves, DEFENDED providers whose salaries are not only higher, but who FORCE consumers to participate in defensive medicine and over-testing EVEN WITH the stunning fact that MEDICAL ERROR is the THIRD leading cause of death in the nation, or DEFENDED insurance companies who still bemoan having to cover any of the sick.

In a clever twist, Obamacare has heralded in the governmentally approved, insurance company created (see AHIP 2008), provider supported notion of a healthcare industry that more and more is designed to TREAT THE WELL.

Having sold us that the healthcare industry is about treating the well, one might have hoped that the villain would have been considered conquered--let the sick die, treat the well in order to maximize financial benefits for government, providers and insurers. But it hasn't worked. Obamacare has failed--Healthcare and health insurance for the healthy and damned the sick is failing because sick consumers are realizing that everything they pay in, everything they go through, everything they try to do is not enough to justify being treated like a CUSTOMER instead of a villain when they're ill or have a NEED for medical care and services.

Obamacare will NEVER work for the consumer even if some misguided souls believe that it worked for them during any particular enrollment year because they managed to squeeze into Obamacare entitlements, managed to stay well, and managed to avoid all the pitfalls of punishment reserved for the imperfect, aging population that is eventually all of us.

But acknowledging that maybe we IDENTIFIED THE WRONG VILLAIN, seems to be an ego hurdle that many are unable to make. What is the biggest problem with our healthcare industry? The answer that those needing health CARE and services, for any reason is the problem is a nutty one, yet nationally, it's what we've bought into. If people were healthy, would we need healthcare services? No. Would we need help paying for those healthcare services? No. That is the beginning and end of the consumer transaction that is healthcare.

So, as the "villains," those sucking out the resources of government and insurance companies trying to pay the prices charged by providers, what do we need? Affordable access to healthcare services if we're sick. So where are the provisions in Obamacare or elsewhere addressing those skyrocketing costs charged to those in need of medial services and care? Nowhere.

Instead providers are incentivized to send us for extensive check-upping and force us to pre-test ourselves to obtain even the most rudimentary of care. It hasn't worked. Death rates in the US are up. Medical errors in the US are up. Malpractice claims? Oh, they're down even though death rates are up and medical errors are up. Prices, yep, they're up too.

Consumers need a la carte services--if providers are afraid of liability, let them have us sign a RELEASE stating that we only wanted a test for strep throat instead of blood pressure screening, diabetes screening or cholesterol screening. We already have to sign a slew of papers, the RELEASE from liability for NOT putting us through the wellness testing wringer is easily included in the RELEASE from liability if their treatment kills us that we're asked to sign.

Consumers need to be freed from the individual mandate: Forcing people to purchase a financial product REMOVES incentive for that financial product to improve. Insurance coverage is WORSE in terms of covering needed medical services and care and is more expensive under Obamacare. Sacrificing our most effective tool as consumers--being able to CHOOSE NOT TO BUY a bad product has not worked in any significant way as each year Obamacare enrollment persistently remains well below anticipated enrollment, this year including between 9.4 and 11.4 million enrollees (according to the government) even with the payouts. Forcing us to purchase insurance hasn't reduced the price increases by insurers as more and more complain more and more that they need to charge more and more. No surprised face there--Greed is limitless and forcing people to purchase a product means they have NO CHOICE, of course insurers are going to charge more. (Note Clinton's proposal to feed the monster by giving illegals the OPTION, [a superior benefit to citizens who are forced,] to buy into Obamacare and satisfy insurers with a new pool of customers).

Consumers need to have a REASONABLE out of pocket maximum: The out of pocket maximum is $6,850 for an individual and $13,700 for a family this year. It's gone up every year. Even as Obama's administration managed to wheedle out of giving a cost of living increase for social security, the out of pocket maximum went up. Hillary Clinton plans to help Obamacare enrollees already receiving government handouts MORE money by giving a $5,000 tax credit on top of the handouts--this should be expanded to EVERYONE, not simply Obamacare enrollees. Further, the out of pocket maximum should be tied to the SAME criteria as the social security cost of living increase--social security recipients get nothing, out of pocket maximum does not go up in a given year.

Provide Incentives for Giving: Anyone who pays for health insurance for another should receive a tax benefit. Obamacare incorporated what was going on already--letting employed parents pay for their underemployed or unemployed children's health insurance through the age of 26. But it hasn't worked because Obamacare also gives young-healthies up through the age of 30 the option of getting the worst coverage (through age 30), or not having any health insurance (in non Medicaid expansion states). Obamacare actually DISCOURAGES people from purchasing health insurance for others by failing to include it as a meaningful form of charity that would also help feed the monster, reducing government liability for Medicaid enrollees, reducing the assertion of insurers that they "can't afford" to insure only the sick and aren't getting enough younger people.

Incentivize Fraud Discovery: Obamacare ENCOURAGES insurance fraud by EXCLUDING it from the permissible 80 percent that insurance companies can spend on "health care costs and quality improvement activities." Instead, pursuing fraud is included in the cherished 20 percent that can go to administrative, overhead, and marketing costs. (https://www.healthcare.gov/health-care-law-protections/rate-review/). Incentivizing the discovery of fraud by CONSUMERS with shared financial benefit, much like other whistleblowers receive, would encourage insurers to do more than threaten their insureds that their prices go up because of fraud and would instead REWARD them for going after insurance fraud.