Thursday, March 16, 2017

Health Insurance vs. Health Care

They are not the same

Prior to the Affordable Care Act going into effect in 2010 (was it really that long ago?) I remember all the hype, all the debate and the marketing touting it as a huge improvement in health care for Americans. As someone who was actually paying attention in the early years to what this law would actually do, I was always surprised at this argument and how so few were listening to those who actually "got it". The ACA did very little, if anything, to improve health care, and wasn’t really intended to. It also didn’t do anything, and wasn’t really intended to reduce the cost of health care. In some ways, it increased the cost of health care (through various taxes and fees).

The ACA was intended to lower the cost of, and therefore increase access to health insurance. The reasoning was that if more people could be covered by health insurance, more people would be able to access quality health care. Noble intentions. Unfortunately, for various reasons, those intentions have not been realized. Access to health insurance does not equate to access to health care. While more people may be able to afford an insurance policy, that does not mean they can afford to get actual health care. High deductibles, co-pays and co-insurance make it very difficult and sometimes impossible for many people to actually use their newly gained health insurance. Maximum out of pocket limits be damned – if you can’t afford to go the doctor, or get the treatment your doctor recommends because you don’t have an extra $2000 or more (for an individual) laying around to cover the deductible, and then the additional costs of co-pays and co-insurance, you still don’t have access to health care. Those figures rise with plans with lower premiums and with family plans.

Over the past seven years, there have been numerous analyses on the failures – and some successes – of the ACA, and I won’t reiterate them here. If you’re not aware of this, you can easily find them through a simple Google search. But suffice it to say that whether you are talking about how the law affects individuals, or the failures of the risk corridor plans, or any other aspect of the law – it isn’t working anywhere near its original goals.

Now, with the release of the Republican’s initial try at repealing and replacing the ACA – the American Health Care Act – the debate is raging again. 

The problem is that the real issues are still not being addressed. First and foremost, let’s be clear: this is about the individual market – meaning insurance purchased by people who do not have access to an employer’s group plan or some government program. The group market (employer-based insurance) works quite well. Yes, premiums are rising in the group market as well, because the cost of medical care is high, and continues to rise. But insurance available through most employers is by far less expensive and covers more than plans available to individuals.

As someone with first-hand experience with insurance in the individual market, I can tell you that it is not "affordable" and I have difficulty seeing how someone of lesser means is able to get quality health care on a regular basis with current individual plans. Whether you purchase a plan through an Exchange, or directly from the insurance company, the plans are all the same (as required by the ACA). 

I believe the most important issue underlying this whole debate/discussion is that the cost of medical care in the United States is ridiculously high and keeps growing. No insurance policy is going to cure that problem. No law that pretends to extend access to insurance coverage to everyone is going to cure that problem. And yet, there doesn’t seem to be much effort expended on addressing this issue – partly because there continues to be this ridiculous penchant for equating health insurance with health care.

Will the American Health Care Act be any better, once it reaches its final form? Probably not. Any such efforts (whether the ACA or the AHCA) will continue to fail for many reasons. Until we address the actual cost of medical care, there doesn’t appear to be any solution that will work for everyone or even most everyone.

What’s the answer? I have no clue. But, then again, I’m not being paid to find the solution; I haven’t been elected by my constituents to find the solution. And frankly, I doubt the people who are being paid, and who have been elected, are capable of finding that solution. Another thing people neglect to understand is that none of these people have to worry about their health insurance. I’d be willing to bet none of them really understand what current individual health insurance policies actually cover or cost. If they’ve ever had to purchase an individual plan (I doubt few of them have), they can afford to purchase the highest level plans and can afford the huge premiums attached to those plans. The rest of us can’t. 

I’d love to sit down and have a discussion with the likes of Nancy Pelosi or Paul Ryan to hear what their health insurance plans cost them, what they cover, and most importantly, if they truly understand all the issues facing people who must purchase their insurance on the individual market.

1 comment:

  1. This is a painfully lucid article. The millions that have added access to health care through Medicaid are treated to lower quality, longer wait times and limited access to sophisticated procedures. Sure they have "coverage", but is it good coverage? No.