There was a time when I would've considered the ACA unnecessary. That I would've been annoyed by it. This was also a time where I had little to no interest in politics. It's funny how life has a way of humbling a person and teaching them something new about themselves on a regular basis. This is a story about how I ended up needing the help in order to make myself better.
"Well why didn't you just get a new inhaler?" I felt a sinking pit in my stomach. I was at a follow up visit to my doctor after ending up in the ER a few weeks before because bronchitis had made my asthma worse and I couldn't breathe. The first thing my doctor asked me was where my inhaler was when this had happened. After all, that was in my plan. I tried to explain to her that I only had one inhaler and it had been stolen the week before when I was riding the bus. Somehow, despite my explanation she didn't understand that since I was uninsured at the time, I just couldn't afford a new one. It was only after the ER trip that a friend of mine had pity on me and bought the inhaler for me.
I lost my insurance in April 2012 because I had been working at a call center that had outsourced its customer service department overseas. This was my fourth lay off in about six years. The whole time I had been trying to go back to school but in playing musical jobs I had never managed to do so. I decided to make school my focus and work secondary and deal with it.
Because I have asthma, I've never been able to get insurance without going through my work before. COBRA would've cost me over six hundred a month, and while my state had opened a high risk pool, it was still too expensive. My NP was awesome and made sure I got refills of my medication before I lost my insurance and gave me a list of community services for when I did lose it, because she knew I wouldn't be able to come back afterwards.
I did everything I could to make sure I would be taken care of. I signed up for a prescription plan at a local pharmacy, I found local clinic that was free, run on community donations. Still there are things that free clinics couldn't handle. Waiting all week to see a doctor because you got sick on Sunday and the free clinic is only open on Saturday isn't helpful when you're so sick you can't breathe. The doctors are volunteers so there's no guarantee of continuous care. In fact, the push is to get you into a local public health or community clinic, but they often were not taking new adult patients or were an hour drive away.
It was about a month after I lost my insurance when I found a lump on my right side, along the edge of the breast tissue. The free clinic provided me a referral but when I called the places they suggested I was turned away. I was told I was too young, that the office no longer provided services, or that they were out of funds for the year. I continued to fight to find a way to access services, but without a referral from a PCP I was getting nowhere. I finally took the time to bus out to one of the few clinics taking patients. They contacted a local imaging center attached to a public hospital to get me in. This started in June, I was finally in for imaging in October. In November I would get a biopsy and find out it was benign. It took me six months from start to finish to find out what was there.
It would be another year before I would get insurance again. In that time I ended up in the ER enough times the doctors started to recognize me. There really wasn't anything either of us could do. I couldn't manage my health without being able to afford regular doctor's visits and medication and they couldn't make a solution appear out of thin air. My wisdom teeth got infected and had to be removed but had to wait two months for a dentist who would help. I was on antibiotics so long I ended up with a GI infection. Bronchitis, allergic reaction, a set of second degree burns from how bad at cooking I can be. They got to deal with it all, despite the fact that most of these things were preventable.
All if this changed in January of last year. I live in one of the states that approved the Medicaid expansion and set up their own healthcare exchange. I was there on day one to shake hands with the Governor, tell him my story, and sign up. I stood up with him to others to encourage them to use the exchange as well. It is the only day of class I've missed since I started back.
Because of the Affordable Care Act I was able to get needed blood work that I had not been able to afford. Reliable access to medication. The first thing my PCP did, remembering how just a few months earlier I had ended up in the ER because I didn't have an inhaler was make sure to get me a prescription for one so I had a backup. One thing I know is I appreciate the opportunity more than I could ever express.
I know there are naysayers out there who will tell me that those things are not really free and that someone has to pay for them. One day I'll graduate and that person will be me. I seriously hope that I am paying to make sure someone gets the care they need with the money I pay into the system. It's saner than paying for what happens when they can't. The system we have isn't perfect, but it can only get better if we put effort into it.
Specializes in NICU, PICU, Transport, L&D, Hospice.
I feel the same about ours (NZ)
Mum is currently undergoing palliative treatement for cancer. Such a load off, knowing the cost of it is met by the system. If it gets to the point we cant care for her at home, we can get her admitted into a hospital for end of life care
I believe that American's don't want a universal single payer system because they believe that means that they, through their taxes, are then paying for the health care of other strangers that they know and care nothing about. We live in a society which has been in the business of demonizing the poor relative to any government assistance they might receive. This, in my view, has encouraged millions of American's to adopt a very self centered perspective when it comes to taxes for social programs. Americans are, IMV, arrogant, violent, increasingly ignorant, and amazingly stingy for a citizenry which largely considers itself to be "Christian". We could do better.
Specializes in Critical care, tele, Medical-Surgical.
I think if most Americans really learned and thought about it they would support a single payer system, expanded Medicare for all of us.
All of us including elected politicians and those who lose the election too. For people between jobs, babies, children, and young adults. Not just 80% coverage for us old people.
We won't have to spend as much when we eliminate the advertising costs, shareholder dividends and/or speculation, and enormous insurance company executive compensation especially stock options.
One of the reasons I favor a health care system using health care savings accounts (if you look at how much money was spent on ACA to date, and do a what if they split it among the 319 million Americans' and each would have several million in their account) rather than government regulation of health insurance (which can be rejected by providers).
I'm not sure to begin with your math there, giving each american "several" (if we use only 3 to quantify "several") million dollars, that would cost $9,570,000,000,000,000,000,000,000. And if by "cost" you're referring to increased healthcare spending compared to before Obamacare then you're actually talking about a negative number, since the ACA saves more than it adds in terms of costs.
The current system is pure wealth redistribution (which is why there is panic over the subsidy issue at the supreme court). If it was pure health care savings accounts, since almost all (if not all) locations accept cash or cash equivalents, you get close (or 100%) universal access to health care (which insurance cannot even come close), no wealth redistribution (which means no theft of one person to cover another person), and a lot more responsibility.
Thank you.
Yes, health insurance is wealth redistribution, that it's whole purpose, without that redistribution many thousands of people would die and suffer unnecessarily every year. Maybe being OK with that is something we're heading towards but I don't think such societal immorality is something we're generally accepting of, at least not yet.
An HSA based system would mean drastically cutting the currently available services. The potential costs of healthcare are many times that of what the vast majority of people can cover independently, even with an entire lifetime to save up, which is why we "redistribute" those costs.
You are thinking of HSA's in today's context. A healthcare system with HSA's as it's foundation would be much different then what we have today.
There has been much discussion about this over the past few years if you look outside the liberal press. There has been much discussion about it on AN. I can't fault you for not being knowledgable about it, many aren't. But, you may wish to refrain from labeling people "misinformed".
HSA's, and other forms of paying for healthcare without the contributions of others, is already the foundation of health insurance. You pay what you can yourself, and then for costs beyond that we use a shared pool of funds.
I've honestly never seen an HSA-only health coverage proposal in any type of press, maybe you could refer me to an example of this.
If you were to try and build such a system, it would soon hit a mathematical road block. If we're talking about how to cover services that might peak at say, $20,000, it would be reasonable to expect that the majority of people will pay those costs themselves in one way or another, including HSA's. There would still be some however that wouldn't be able to pay that total at any point, so a smaller amount would have to go to some sort of shared fund. When the potential peak costs are much higher than that, the ratio of what we can expect people to be able to save up on their own becomes much small relative to the amount that has to be put into a shared pool to pay those costs.
Quarter-million dollar hospital stays are not uncommon, and I've had a number of patients hit coverage limits of $1 million or more. With those types potential peak costs a sizable portion of what we're able to put towards healthcare has to go into that shared pool, which is what we have now.
It sounds ideal, but realistically how would an HSA-only system work? Specifically what happens when someone can't save up enough to cover their eventual healthcare costs? What happens when someone does save up enough but then has a health condition that empties their account, then they end up needing more care?
I said in my post # 642 above: "a HSA does not make health care any more accessible or affordable as it excludes people who either are not wealthy enough to buy an individual high deductible plan which is necessary in order to contribute to a HSA, and who therefore would not be able to benefit from any potential tax savings, and also excludes people who are not fortunate enough to be offered a high deductible plan/health savings account by their employers."
I did not say, as you are suggesting I did, that "only the wealthy can afford a high deductible plan" (I presume you are inferring that I said that only the wealthy can afford to purchase a high deductible plan; that is different from what I actually did say, if you re-read my post above, where I said that HSA's exclude people who are NOT WEALTHY ENOUGH TO BUY AN INDIVIDUAL HIGH DEDUCTIBLE PLAN, and excludes people who are not fortunate enough to be offered such plans by their employers.
Here is how HSA's exclude people who are not wealthy enough to buy an individual high deductible plan (this also applies to many people who receive access to a high deductible plan/HSA through their employment) and this does not just refer to the cost of the premiums: While PREMIUMS for high deductible plans may cost less than various other plans, there are many more associated costs with high deductible plans/HSA's. Studies have shown that a large number of families with above average income with high deductible plans have postponed medical care, as many families can incur expenses that are greater than their HSA yearly contribution limits. If families with above average income are deferring care, then HSA's are clearly not suitable, as I see it, for people of lesser means, as they do not improve access/affordability of care.
People who can afford to fund HSA's, either individually or through their employment, are able to set aside extra funds for this purpose, and aim to receive tax benefits by doing so. The purpose of the ACA is to improve accessibility/affordability of medical care. It stands to reason that the people who will benefit most from HSA's are people who can easily fund HSA's to the maximum yearly contribution limits, who will benefit from the tax advantages, and who will not need to put off receiving care because of the costs.
You are correct. When you said, "HSA's exclude people who are NOT WEALTHY ENOUGH TO BUY AN INDIVIDUAL HIGH DEDUCTIBLE PLAN", I did infer that "only the wealthy can afford a high deductible plan". Boy, do I feel silly.
And I agree with you. The high-deductable, HSA plans that the Obamacare has forced onto many people has not done enough to improve accessability and affordability.
It sounds ideal, but realistically how would an HSA-only system work? Specifically what happens when someone can't save up enough to cover their eventual healthcare costs? What happens when someone does save up enough but then has a health condition that empties their account, then they end up needing more care?
Really? Aren't you bored with going back and forth with me on this over the past few years?
Well, someone has to do it when you keep posting the same propaganda, over and over and over again.
Here is what I said:
"You are thinking of HSA's in today's context. A healthcare system with HSA's as it's foundation would be much different then what we have today."
Propaganda? Seems like a pretty benign post.
You obviously didn't read the conversation. Just saw that one of your buddies (Muno) replied to someone (me) who in the past has had differing views then you and decided to take a cheap shot. Kind of pathetic if you ask me.
Thanks for the reminder as to why I don't waste my time here as often as I used to.
Really? Aren't you bored with going back and forth with me on this over the past few years?
Apparently not.
I'm still interested in how that could work since you keep proposing that idea but have never offered specifics on how it could work. It's sort of like if someone were to say "we should just keep our current system but at no cost to anyone". That's a great goal if it's actually possible, but figuring out that could work is the hard part.
Under our current system, we're only paying the costs that actually occur and it's still arguably too expensive. You're suggesting we not only pay the costs that actually occur (though you haven't offered how) but everyone's potential costs as well by putting what would have to be close to $1 million into 315 million dedicated accounts, which would require exponentially increasing the amount of money we're putting towards healthcare, in other words we'd be paying a lot more and at the same time making healthcare itself fiscally insolvent. Personally I think our goals should be the opposite; pay less while making healthcare delivery more fiscally solvent.
Specializes in NICU, PICU, Transport, L&D, Hospice.
Really? Aren't you bored with going back and forth with me on this over the past few years?
I wonder too.
Yet, the same sort of ideas and possibilities continue to be floated without the benefit of any discussion of what that might look like, how it might be designed, etc.
Without anything to flesh out this sort of a plan/concept it simply begins to simply look and sound like meaningless noise, propaganda, etc.
Yet, the same sort of ideas and possibilities continue to be floated without the benefit of any discussion of what that might look like, how it might be designed, etc.
Without anything to flesh out this sort of a plan/concept it simply begins to simply look and sound like meaningless noise, propaganda, etc.
You can go to posts #82 and #85, and then go from there if you want. You may not think the ideas are good, but please don't pretend there hasn't been discussion.
And have you not heard of these ideas and possibilities other places?
Specializes in NICU, PICU, Transport, L&D, Hospice.
How are those ideas different from what we currently have?
We have HCAs
We do have health insurance exchanges
etc
I'm not pretending that there hasn't been "discussion", it is just not clear how the suggestions are different from the status quo or different from what was available before the ACA?
It is difficult to understand the depth of the animus about the ACA when the reported conservative alternatives look a great deal like the ACA. Why hate the ACA when it could just be tweaked a bit to better reflect the conservative heritage that it enjoys?
toomuchbaloney
16,070 Posts
I believe that American's don't want a universal single payer system because they believe that means that they, through their taxes, are then paying for the health care of other strangers that they know and care nothing about. We live in a society which has been in the business of demonizing the poor relative to any government assistance they might receive. This, in my view, has encouraged millions of American's to adopt a very self centered perspective when it comes to taxes for social programs. Americans are, IMV, arrogant, violent, increasingly ignorant, and amazingly stingy for a citizenry which largely considers itself to be "Christian". We could do better.