Everybody has a preexisting condition even if at the moment you seem perfectly healthy. To deny insurance coverage for that reason is utterly foolish and irresponsible. I can certainly give the ACA credit for that. Even though younger people are likely to be more healthy they are not immune to accidents. Sometimes genetic diseases don’t make appearances until one is a little older. Healthcare should be affordable and available to everyone.
>"Even though younger people are likely to be more healthy they are not immune to accidents"
Just look to the Denver Broncos football team. Their linebacker Alex Singleton was in the prime of health at 31 years old and they discovered testicular cancer just this month. The medical care and operation costs are many tens of thousands of dollars. What 30 year old has that kind of cash laying around?
Younger people are developing type II diabetes at a higher rate now, and obesity and its inherent problems is also on the increase. There are also, as you point out, genetic conditons that can flare up at any time in life.
Personal stories bring home the import of affordable health insurance, so thank you, Norm. As a self-employed person in my healthier years, I was forced to go without any insurance for decades, as my choice was having a business or going to work somewhere that I could get on a health plan. How overjoyed I was to let the stress of that reality go when Obamacare came along. I paid into it happily for 15 years.
After a bad year, I was thrown off of ACA and onto Medicaid last year. Imagine my surprise that this system worked so well for me, now in less healthy times. And while I saved money thanks to my state coverage, the system overall saved money because I was not turning to an ER as an indigent patient. And because I managed my health, I was able to work and contribute taxes and cash to the local economy.
The stress of not having health insurance is real and detrimental. The opposite situation is real and positive. A wise society will choose the latter.
This is an illuminating report and indicates that we more and more need a single-payer system and to get the leaching for profit insurance companies out of the loop. As 'middlemen' they add nothing to care, add to costs, add to providers' bureaucracy, and are far from straightforward. The supplemental advertising on television is also annoying - money better spent on delivering affordable care if we must have them at all. We already have Medicare and the VA as government provided systems that deliver efficiently. We need to expand that concept to all.
The Republicans have an alternative to Obamacare. They have I Don't Care. You get sick, tough luck, they don't care. The Republican's think you should have been born rich or married to a rich family.
Or get elected to congress.
They've got comprehensive free coverage that is funded by taxpayers.
Having for profit insurance gatekeepers in the healthcare market as we have now is NEVER going to work.
Single payer, or a couple of options like buy into Medicare, or Tricare, and fund them, is the inky sensible thing. The bullshit of trillions of plans, none of which care for people, and cost a fortune to administer, are the very essence of waste fraud and abuse.
Insurance companies to insure that the insurers don't loose money when they're sued for wrongful death due to denial of care is also bullshit.
No wonder physicians are leaving their livelihood and telling kids absolutely do not go into medicine.
You know what does work? My state Medicaid plan, because they aren't looking to make a profit, plain and simple. Funny that Kaiser, which is supposedly a nonprofit, can't seem to fund what Medicaid funds and can't give me the same level of care. But they sure are interested in selling me supplemental Medicare insurance--and they're starting while I am nowhere near 65 yet! Maybe save some stamps, guys and save the money for your patients.
Norm, this is a good place to outline the options that we have for health care spending as a framework for understanding the discussions that will follow:
1. No insurance, total free market approach. An example: "Mr. Smith you were in the hospital for three weeks, you are perfectly well now. We will need a check for $876,231.26." Don't laugh, some Republican plans are not much better. A $75000 bill you can't afford to pay could be just as deadly to your finances.
2. Private insurance. The article above explains that well. High deductible plans, the Republican plan to let insurance companies compete across state lines, and the vagaries of a profit-driven business model cause innumerable problems and are basically unworkable. Insurance is frequently tied to a job, and if you lose your job, you lose your insurance though you can continue it at your expense for a time through COBRA.
3.Government issued insurance policies. This model is used in some European countries. Everyone gets a basic insurance policy. If you have the wherewithal, you can spend some of your own money and upgrade the basic policy. Obamacare is a messy example of a government supported insurance plan.
4. Single payer, where the government takes care of your medical expenses.
Any other type of plan brandished by a Republican politician should be ignored. I've reviewed the outlines of dozens of these proposed over the years by Republicans and they are all ridiculous and unworkable.
Single payer and government-supported insurance are expensive and require taxation to fund them. Experience in countries that have these plans shows difficulties in funding them, given the high cost of medical care, and in providing expedient access to services. Nonetheless, they serve a greater proportion of the population better than other approaches.
Keep these points in mind when you read about healthcare financing.
I understand that is how Medicare Advantage was created. Advantage plans are just regular insurance plans, and should not have the label "Medicare" attached.
You are correct, and some of them are only an 'advantage' for the insurance companies, and others border on scams. Anyone who signs up for one of these should be very careful to read all of the fine print, and if it cannot be easily understood, sign nothing until an independent explains it.
Well written and understandable. I especially agree that "considering that efforts by Health and Human Services secretary Robert F. Kennedy Jr. and his conspiracy-addled cohorts will add pressure to health costs by creating more openings for epidemics and pandemics and eviscerating research into deadly diseases, the protections of the ACA become even more important." I hope the United States is able to have a reasonable health insurance system that works to keep people healthy.
Thank you Norm. I have an adult son with disability. He maxed out two $1M lifetime caps and is relatively unemployable…because of language comprehension and seizures. What will happen to him when I’m gone? It’s terrifying.
No one has mentioned the fact that we who are using the ACA have a December 15 deadline to choose our plans for 2026. Once we choose, that is unchanging until we choose again for 2027. I, like many, have to decide to keep my current plan that will go from $450/month to $1150/month or to choose a lesser but cheaper plan that does not include my current doctors. No one has addressed this. If by some miracle congress votes to continue the ACA subsidies, will the insurance companies allow us to change back to our 2025 plans mid- year? Do I keep my now much more expensive plan so I can keep my doctors with the hope that I won’t have to pay that full new price or will get some kind of refund if congress votes to reinstate subsidies?
I already have to buy my medicine from New Zealand, and are now paying a 15% tariff because my insurance has denied my medicine even when my doctor tried to fight for me.
I think congress should have to use the ACA instead of their premium lifetime special insurance and then they would not be making these choices.
The sudden concern and rush to "fix" health insurance by the Republicans is frightening. It comes, of course on the backlash from the shutdown as Democrats caved, but the public spoke in anger. The elections are near, so the Republicans needed to react. Unfortunately, it is not based on a concern for the health of our country.
Instead become an opportunity for the Republicans to renew their call for the elimination of the ACA. Trump said he is not interested in fixing it, he wants to eradicate it. Mike Johnson has "concepts", others float the consumer of health care model, cutting small checks directly to "consumers", so they can "shop around" and choose a plan. Your personal experience alone, puts what should be the obvious lie and impartibility to this idea.
It is the health care system that needs to be fixed. Today we no longer have health care institutions but corporations, looking to profit from sickness and health. Doctors are now employees with productivity goals, reduced to cubicles medical buildings. The health care we receive comes from a single run corporation of hospitals, clinics, emergency care centers, medical providers, testing centers and pharmacies. The group that one can access is defined as being in the network defined by one's health insurance provider. Try to get a needed appointment with your PCP: if it's not for a checkup, (you had to make that at the last one, for 6 months from that date), you are told to go to one of your group's satellite walk-in emergency centers.
The bottom line and profits are therefore preserved at both ends of a health scale: deny needed care through pre-authorization; make it difficult, if not impossible for every day, ordinary needed or preventative care.
If the Republicans keep following Trump's orders (and do we doubt that they will, MGT, not withstanding, although they do need their constituents to vote), there will never be a renewed or reformed ACA. Let's remember that destroying ACA is one of Trump's longstanding and top grievances. Just that it is named after his nemesis would be enough to raise his ire; add the fact that John McCain ("I don't think of him as a hero, he got captured") cast the defining vote that would have ended the ACA.
Unless the cracks in the MAGA movement widen to fault lines, more citizens will be unable to afford health care, more will remain ill and untreated, preventable diseases will spread, and people will die. And this means nothing to a man with no heart, only a brain bent on revenge.
Everybody has a preexisting condition even if at the moment you seem perfectly healthy. To deny insurance coverage for that reason is utterly foolish and irresponsible. I can certainly give the ACA credit for that. Even though younger people are likely to be more healthy they are not immune to accidents. Sometimes genetic diseases don’t make appearances until one is a little older. Healthcare should be affordable and available to everyone.
>"Even though younger people are likely to be more healthy they are not immune to accidents"
Just look to the Denver Broncos football team. Their linebacker Alex Singleton was in the prime of health at 31 years old and they discovered testicular cancer just this month. The medical care and operation costs are many tens of thousands of dollars. What 30 year old has that kind of cash laying around?
Younger people are developing type II diabetes at a higher rate now, and obesity and its inherent problems is also on the increase. There are also, as you point out, genetic conditons that can flare up at any time in life.
Personal stories bring home the import of affordable health insurance, so thank you, Norm. As a self-employed person in my healthier years, I was forced to go without any insurance for decades, as my choice was having a business or going to work somewhere that I could get on a health plan. How overjoyed I was to let the stress of that reality go when Obamacare came along. I paid into it happily for 15 years.
After a bad year, I was thrown off of ACA and onto Medicaid last year. Imagine my surprise that this system worked so well for me, now in less healthy times. And while I saved money thanks to my state coverage, the system overall saved money because I was not turning to an ER as an indigent patient. And because I managed my health, I was able to work and contribute taxes and cash to the local economy.
The stress of not having health insurance is real and detrimental. The opposite situation is real and positive. A wise society will choose the latter.
Yes, a national health insurance plan would be great for small businesses. And also cut expenses for all businesses.
This is an illuminating report and indicates that we more and more need a single-payer system and to get the leaching for profit insurance companies out of the loop. As 'middlemen' they add nothing to care, add to costs, add to providers' bureaucracy, and are far from straightforward. The supplemental advertising on television is also annoying - money better spent on delivering affordable care if we must have them at all. We already have Medicare and the VA as government provided systems that deliver efficiently. We need to expand that concept to all.
The Republicans have an alternative to Obamacare. They have I Don't Care. You get sick, tough luck, they don't care. The Republican's think you should have been born rich or married to a rich family.
Or get elected to congress.
They've got comprehensive free coverage that is funded by taxpayers.
Thank you for this excellent post Norm
Having for profit insurance gatekeepers in the healthcare market as we have now is NEVER going to work.
Single payer, or a couple of options like buy into Medicare, or Tricare, and fund them, is the inky sensible thing. The bullshit of trillions of plans, none of which care for people, and cost a fortune to administer, are the very essence of waste fraud and abuse.
Insurance companies to insure that the insurers don't loose money when they're sued for wrongful death due to denial of care is also bullshit.
No wonder physicians are leaving their livelihood and telling kids absolutely do not go into medicine.
You know what does work? My state Medicaid plan, because they aren't looking to make a profit, plain and simple. Funny that Kaiser, which is supposedly a nonprofit, can't seem to fund what Medicaid funds and can't give me the same level of care. But they sure are interested in selling me supplemental Medicare insurance--and they're starting while I am nowhere near 65 yet! Maybe save some stamps, guys and save the money for your patients.
You are so correct in your observation.
Norm, this is a good place to outline the options that we have for health care spending as a framework for understanding the discussions that will follow:
1. No insurance, total free market approach. An example: "Mr. Smith you were in the hospital for three weeks, you are perfectly well now. We will need a check for $876,231.26." Don't laugh, some Republican plans are not much better. A $75000 bill you can't afford to pay could be just as deadly to your finances.
2. Private insurance. The article above explains that well. High deductible plans, the Republican plan to let insurance companies compete across state lines, and the vagaries of a profit-driven business model cause innumerable problems and are basically unworkable. Insurance is frequently tied to a job, and if you lose your job, you lose your insurance though you can continue it at your expense for a time through COBRA.
3.Government issued insurance policies. This model is used in some European countries. Everyone gets a basic insurance policy. If you have the wherewithal, you can spend some of your own money and upgrade the basic policy. Obamacare is a messy example of a government supported insurance plan.
4. Single payer, where the government takes care of your medical expenses.
Any other type of plan brandished by a Republican politician should be ignored. I've reviewed the outlines of dozens of these proposed over the years by Republicans and they are all ridiculous and unworkable.
Single payer and government-supported insurance are expensive and require taxation to fund them. Experience in countries that have these plans shows difficulties in funding them, given the high cost of medical care, and in providing expedient access to services. Nonetheless, they serve a greater proportion of the population better than other approaches.
Keep these points in mind when you read about healthcare financing.
Have you noticed?
No one has asked any of us what we want or what we do not want.
What we are getting is being shoved down America's collective throat!
How un American.
The insurance lobby has a lot to do with this 'shoving' as it influences legislation and regulation of the "industry".
I understand that is how Medicare Advantage was created. Advantage plans are just regular insurance plans, and should not have the label "Medicare" attached.
You are correct, and some of them are only an 'advantage' for the insurance companies, and others border on scams. Anyone who signs up for one of these should be very careful to read all of the fine print, and if it cannot be easily understood, sign nothing until an independent explains it.
Well written and understandable. I especially agree that "considering that efforts by Health and Human Services secretary Robert F. Kennedy Jr. and his conspiracy-addled cohorts will add pressure to health costs by creating more openings for epidemics and pandemics and eviscerating research into deadly diseases, the protections of the ACA become even more important." I hope the United States is able to have a reasonable health insurance system that works to keep people healthy.
Thank you Norm. I have an adult son with disability. He maxed out two $1M lifetime caps and is relatively unemployable…because of language comprehension and seizures. What will happen to him when I’m gone? It’s terrifying.
What a stressful situation to live with. I hope something workable is on the horizon.
No one has mentioned the fact that we who are using the ACA have a December 15 deadline to choose our plans for 2026. Once we choose, that is unchanging until we choose again for 2027. I, like many, have to decide to keep my current plan that will go from $450/month to $1150/month or to choose a lesser but cheaper plan that does not include my current doctors. No one has addressed this. If by some miracle congress votes to continue the ACA subsidies, will the insurance companies allow us to change back to our 2025 plans mid- year? Do I keep my now much more expensive plan so I can keep my doctors with the hope that I won’t have to pay that full new price or will get some kind of refund if congress votes to reinstate subsidies?
I already have to buy my medicine from New Zealand, and are now paying a 15% tariff because my insurance has denied my medicine even when my doctor tried to fight for me.
I think congress should have to use the ACA instead of their premium lifetime special insurance and then they would not be making these choices.
If everyone who benefited from these provisions of the ACA would have voted for the party that created it, we would not be in the mess we are in now.
The sudden concern and rush to "fix" health insurance by the Republicans is frightening. It comes, of course on the backlash from the shutdown as Democrats caved, but the public spoke in anger. The elections are near, so the Republicans needed to react. Unfortunately, it is not based on a concern for the health of our country.
Instead become an opportunity for the Republicans to renew their call for the elimination of the ACA. Trump said he is not interested in fixing it, he wants to eradicate it. Mike Johnson has "concepts", others float the consumer of health care model, cutting small checks directly to "consumers", so they can "shop around" and choose a plan. Your personal experience alone, puts what should be the obvious lie and impartibility to this idea.
It is the health care system that needs to be fixed. Today we no longer have health care institutions but corporations, looking to profit from sickness and health. Doctors are now employees with productivity goals, reduced to cubicles medical buildings. The health care we receive comes from a single run corporation of hospitals, clinics, emergency care centers, medical providers, testing centers and pharmacies. The group that one can access is defined as being in the network defined by one's health insurance provider. Try to get a needed appointment with your PCP: if it's not for a checkup, (you had to make that at the last one, for 6 months from that date), you are told to go to one of your group's satellite walk-in emergency centers.
The bottom line and profits are therefore preserved at both ends of a health scale: deny needed care through pre-authorization; make it difficult, if not impossible for every day, ordinary needed or preventative care.
If the Republicans keep following Trump's orders (and do we doubt that they will, MGT, not withstanding, although they do need their constituents to vote), there will never be a renewed or reformed ACA. Let's remember that destroying ACA is one of Trump's longstanding and top grievances. Just that it is named after his nemesis would be enough to raise his ire; add the fact that John McCain ("I don't think of him as a hero, he got captured") cast the defining vote that would have ended the ACA.
Unless the cracks in the MAGA movement widen to fault lines, more citizens will be unable to afford health care, more will remain ill and untreated, preventable diseases will spread, and people will die. And this means nothing to a man with no heart, only a brain bent on revenge.
The insurance companies are to blame.