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My dog needed surgery last month, and the veterinary office handed me an estimate of charges. Try asking for an estimate from a doctor or hospital. It won’t happen. Their attitude and ours seem to be, it costs what it costs. And we all know they will sock the insurance company, so we don’t care.
Because our health-care system relies on socking the insurance company, insurers and health plans have come up with their own ways of socking us back – denied claims, bigger co-pays, cancelled coverage if you’re too sick, denied coverage if you have a pre-existing condition, and capped lifetime payout.
Much of our health-care debate demonizes insurance companies, but they’re just another fly in the web. Americans don’t like the idea of a single-payer (government), so we need insurers, and mandatory coverage was one of many compromises in the Affordable Care Act.
After the long labor and breach birth of ACA, I wrote that it still needed work, but it was a start. Now critics want to throw the baby out with the bath water.
From candidates on both sides, we’re now hearing big promises and big lies. Here are a few basics to help you keep some perspective:
The pros: Millions of uninsured will be insured, young adults (23,000 in New Mexico) stay on their parents’ insurance until they’re 26, you won’t lose insurance if you get sick or face a lifetime caps on payouts, certain preventive measures are covered, and the prescription-drug doughnut hole for seniors is covered.
The cons: Government requires you to have insurance or pay a tax, we don’t have enough medical professionals to see millions of new patients, costs might force employers to reduce or eliminate coverage, reforms could cost more than estimated, and new costs could slow economic recovery.
The status quo: Nearly 50 million people (424,000 New Mexicans) lack coverage, 22,000 people die every year (1,400 New Mexicans) for lack of health-care access, New Mexicans pay the highest premium surcharge in the country to help cover the uninsured who need care, and you can lose your insurance through job loss.
Unresolved issues: Cost, quality, prevention and personal responsibility.
Five years ago, Jim Hinton, CEO of Presbyterian Healthcare Services, said we must provide health-care coverage for everyone, and as long as some people can opt out, it shifts the burden to those with insurance and their employers. With everyone in the system, “we can start to eliminate a huge portion of the inefficiency — people seeking crisis care that could have been avoided, straining hospital emergency rooms; people lurching from insurance to no insurance and back again.”
In the gusts of hot air from critics, I keep waiting for Plan B, but there is no Plan B. Last week Rep. Steve Pearce described what he didn’t like in “Obamacare” and said we need to repeal ACA and replace it with “patient-centered approaches,” whatever that means. Where is the alternative we can scrutinize as we’ve scrutinized ACA?
A repeal assumes Congress will come up with a new plan, but Congress can’t even decide what to have for lunch. Repeal ACA and then what? See status quo, above.
The last time Republicans offered an alternative, in 2009, they proposed capping medical malpractice judgments, selling insurance policies across state lines, permitting small businesses to pool coverage for employees, and helping states with high-risk insurance pools. This is well and good, but, according to the Congressional Budget Office, it wouldn’t insure any more people.
One number stands out — the 22,000 who will die. Do we care about them? From the meanness woven through the current debate, I wonder. Still, I still believe Americans are better people than that. If we care, we need to keep this baby and help it grow up.
New Mexico News Service