Thursday, March 9, 2017

Is it about Health Insurance...or Health Care?

Even as "Obamacare" is imploding from costs that are not covered, young people who are not signing up, and premiums that are sky-rocketing, the Media, Ideological Right and Ideological Left point fingers at each other, and talk past each other.  And it is so obvious that one cannot escape the strong suspicion, if not certainty, that they are doing it on purpose to mislead the vast majority of the public.

First, a review of the facts shows that Obamacare has apparently increased the number that is covered by healthcare of some kind.

The difficulty with this claim arises when we ask ourselves if it is insurance, regardless of scope, that we want to extend to people...or is it increased paid-for actual medical coverage that all of us see as the goal.

Healthcare Insurance comes in various least it used come in many forms.  You could chose to select catastrophic insurance plans, where the costs were low because you had no benefit until medical costs exceeded a selected limit...often more than $5,000 for an illness...because you budgeted for normal and ordinary Doctor's visits and accidents.

Then there were the normal, what I used to think of as the Blue Cross/Blue Shield, plans.  These covered normal costs of doctors and hospitals in a variety of ways.  You could chose a network of doctors and hospitals, out of network providers and select any number of co-pay limits and/or drug coverage.

The point of these offerings was to enable any person or family unit to balance cost of premiums against their medical coverage preferences.  Those who had the choice of insurance provided by their employers usually benefited from the employer's negotiating good premium terms, and often had portions of those premiums actually paid by the employer.  But if you left that job, every person had the option of continuing that coverage, albeit at a higher rate.  But you wanted to continue coverage so that you didn't trigger a non-covered period (usually a year or 18 months) for any discovered pre-existing condition.

The motivation for getting, paying for, and continuing Medical Insurance coverage was to protect against preexisting conditions which might or might not develop.  It wasn't enough to have just any policy; you needed to have coverage that was useful.

Obamacare was and remains the equivalent of a con, because it claims to offer a benefit that turns out to be non-existent; the premiums are increasingly exorbitant while the deductibles are so high as to turn the policies into catastrophic only coverage that isn't what most purchasers had before and expected to continue under the promises made by President Obama regarding Obamacare.

And now the Congress is repeating the same mistake.  The only motivation that will cause younger people (and families) to chose to purchase Medical-care Insurance is the fear of discovery of preexisting conditions.  Obamacare proved that a financial penalty wasn't enough if there were no prohibition of coverage due to preexisting conditions.  Besides, without that exception of coverage, what you are trying to provide is NOT insurance at all, but socialized medical coverage.  Without making citizens responsible for the consequences of their planning and their actions, you are socializing the medical costs of everyone.  And that is exorbitantly expensive.

If the government wants to provide ability and incentive for all citizens to have USEFUL medical coverage, provide a limited period (perhaps 18 months) for everyone to select, sign up for, and begin to pay for medical coverage of their choice with coverage for preexisting conditions.  But upon expiration of that period, reinstate the preexisting condition exclusion.

Additionally, for the poor (and there needs to be a certain definition of what that is) set up a means for catastrophic coverage costs to be reimbursed to the purchaser by the government, with the government also picking up any intervening hospital and practitioners' costs upon their supplying factual and audited data.

The key, though, is to mandate that the people themselves have to be responsible for selecting, and processing the necessary applications for coverage and, where appropriate, reimbursement.  If that is done, truly everyone will have the opportunity to access meaningful medical insurance coverage.  But it is opportunity that needs to be provided...not a guarantee.

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