Obama's Health Care Reform A Failure

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Obama's Health Care Reform A Failure

Post by Edi »

Salon.com wrote:Wednesday, Jul 6, 2011 13:01 ET
David Sirota
When health insurance isn't enough
New studies suggest that coverage doesn't protect Americans from going bankrupt over medical costs
By David Sirota

While the contest for the 2012 Republican presidential nomination is already revolving around conservative-themed attacks on "Obamacare," back when the healthcare bill was being legislated, the most important debate was within the Democratic Party, which held large majorities in both houses of Congress. On one side were the drug companies, the insurance companies and President Obama -- the latter who had not only disowned his prior support of single-payer healthcare but had also worked with his corporate allies to actively undermine a modest public insurance option. On the other side were progressives who opposed any bill which further cemented the private insurance industry as the primary mediator between doctors and patients.

Ultimately, Obama and his corporate-backed allies organized enough conservative Democrats in Congress to win, effectively turning healthcare "reform" into a blank-check TARP-style bailout for the health industry. But, of course, to even whisper that last truism is to now run the risk of being labeled a blasphemer in a conversation that can only tolerate misleading red-versus-blue analyses. In today's national political debate, there are Republicans who insist "Obamacare" is a Canadian-style "takeover" of America's healthcare system, and there are Democrats who insist that the health bill is a major Medicare-like achievement -- any other argument, no matter how valid, has been vaporized by election-season pressure to fall in ideological line.

Unfortunately for the political class, however, reality doesn't take orders from partisans -- it persists irrespective of talking points, press releases and Twitter mobs. And on healthcare, the original progressive criticism is now being validated in a new study from Arizona. Going beneath the superficial rhetoric about health insurance and to the reality of actual health care and health costs, the study published by the American Journal of Public Health found:
Health insurance is not protecting Arizonans from having problems paying medical bills, and having bill problems is keeping families from getting needed medical care and prescription medicines, a new study has found... After taking age, income and health status into account, simply being insured does not lower the odds of accruing debt related to medical care or medications. In addition, says University of Arizona College of Pharmacy research scientist Patricia M. Herman, ND, PhD, who directed the study, medical debt is a separate and better predictor of whether people will delay or forgo needed medical care than their insurance status.

"On average, insurance coverage in Arizona is not protecting families from experiencing medical debt," Herman says. "From other studies we knew that paying medical bills is a problem for a substantial portion of both insured and uninsured Americans. This study helped clarify that the fact of medical debt is an additional and larger barrier to getting needed health care than whether a person is insured or not."
With 60 percent of all bankruptcies related to medical costs; with many of those medical-related bankruptcies occurring among those who have private insurance; and with the fear of medical bankruptcy encouraging the insured to unduly skimp on medical services, the Obama healthcare bill did purport to address the issue via caps on out-of-pocket expenses. But those weak caps -- and the bill's failure to achieve universal coverage -- promise to allow the medical debt problem to continue, just as they have in the state whose "reforms" most closely mimic Obama's bill.

As the Los Angeles Times recently reported:
Studying medical bankruptcies in Massachusetts, whose recent healthcare reform was a model for national reform, researchers found that while new insurance rules increased the number of people who had coverage, those rules did not improve coverage -- leaving many still struggling with medical debt... Proponents of the national healthcare reform passed into law last year have claimed that it would reduce medical bankruptcy in the United States by helping more Americans get insurance. This new study, which was published Tuesday in the American Journal of Medicine, suggests that a reduction in bankruptcies is unlikely.
Add to all of this a new Center for Public Integrity report about how American wages are still being eaten up by private health insurance premium increases, and the trajectory is clear: Events are proving that "real reform" and strengthening insurance industry power are mutually exclusive goals. That is, they are proving the veracity of progressives' original criticism of President Obama's healthcare legislation. This is, to be sure, a politically inconvenient truth to both parties and their insurance industry benefactors -- but alas, it is the truth. The longer we simply stare at it -- or pretend it doesn't exist -- the longer the healthcare crisis will continue.
Well, the Obamacare might have been somewhat of an improvement on the shit sandwich that is the US healthscare* system, but seems very much like it was more in the vein of slowing down the acceleration of costs instead of doing anything to actually curb them, which still leads to the same old problem that meaningful health care is functionally unaffordable for vast swathes of the population. In other words, it is a Fail. Perhaps not Epic, but even that is not a given.



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Re: Obama's Health Care Reform A Failure

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I will, however, point out that having any insurance coverage at all makes it much easier to access care, even if it ruins you. Perhaps folks remember my epic quest to get a stupid little tetanus booster a couple years ago - it took me weeks of hunting for a place to get it done and I finally had to cross a state border to get one. For a tetanus booster.

If you don't remember - last post on this, the first page of Healthcare Vents.

So, if there is any silver lining, Obamacare at least enables more people to access the system (even with ruinous bills as consequence) as opposed to being shut out entirely. It's the difference between some healthcare and none at all.

Of course, with such a low mark signifying improvement it just shows how fucked up the US health "system" really is.

We need universal, single-payer health care in the US. And until things change drastically we will never get it.
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Re: Obama's Health Care Reform A Failure

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I have to say that even during the period when I was completely uninsured, if I walked into a doctor's office and plunked down cash I would get what I needed. I believe the phenomenon of refusing care to the uninsured exists, but I've never experienced it and don't understand why (presuming demonstrated ability to pay) it is so.
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Re: Obama's Health Care Reform A Failure

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From what Broomstick mentioned at the time, part of the problem is the assumption that an uninsured patient will probably have a small mountain of medical issues that make treatment complicated and expensive, to the point where they are probably unable to pay. There may also be paperwork issues in certain states or institutions.
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Re: Obama's Health Care Reform A Failure

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Two things: First of all, the vast majority (and arguably the most important parts) of the PPAACA are not in effect yet.

Secondly, the data used in the study is from 2008, before the PPAACA was enacted.

So, yes the study confirms (once again) that the US health care system sucks, but it says absolutely nothing about the PPAACA.
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Re: Obama's Health Care Reform A Failure

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Rogue 9 wrote:I have to say that even during the period when I was completely uninsured, if I walked into a doctor's office and plunked down cash I would get what I needed. I believe the phenomenon of refusing care to the uninsured exists, but I've never experienced it and don't understand why (presuming demonstrated ability to pay) it is so.
Simple stuff wont normally be refused if you have cash, but you you have any idea how much even the most trivial surgery, let alone cancer or heat disease treatment costs? Anybody with the cash to pay for that would have insurance in the first place. Also the US system simply gives hospitals the right to simply refuse to treat anything which is non emergency even if you can pay, and non emergency is basically anything that wont cause you to die within hours.
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Re: Obama's Health Care Reform A Failure

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I may be somewhat off on this but I understand that a hell of a lot of the cost is the doctors' fee? Then if you're in-patient, they charge you for medication, for the use of the room and bed, for anesthesia, X-rays, etc, etc...

Mind you, I'm not arguing that people shouldn't pay doctors' fees or what not. However, I think that compared to other countries, these rates, fees, and incidentals, are probably pretty high.

I had a minor accident a few years ago (slipped on ice and got a nasty knock on the head), and I was in the emergency room for maybe 3 hours. For those 3 hours, in which I spent approximately 5 minutes talking to a doctor, I got charged over $2000 total, almost a good one-third of which was the doctor's fee! I would have been better off not going to the ER in the first place and just heading home to rest for a few days.

When you have a situation like this where being uninsured means that ANYTHING that may land you in the hospital WILL put you into debt unless you've got considerable savings, then obviously something has to change... whether that be offering people a cheap government insurance plan, requesting assistance as individually needed from the government, whatever, but this is pure exploitation, not only of the uninsured, but also of the insurance companies themselves-- if they didn't have to pay so much to the hospitals and the doctors, they wouldn't make insurance so difficult to get.
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Re: Obama's Health Care Reform A Failure

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For comparison, Elheru, if that happened to me and I went to a PRIVATE FOR PROFIT practice, I'd get off with less than €400 probably. Including x-rays, doctor's fees, lab fees etc. I posted the incident with the banged up wrist in the healthcare vents thread and it gives some numbers.

If you hit your head hard on something, going to the doctor is a good idea, because it doesn't take a whole lot of blunt force trauma to the head to cause cerebral hemorrhage or something like that which doesn't have any symptoms to begin with but kills you really fucking dead in short order if you don't get treatment straight away. The typical way it happens, you hit your head, figure nothing happened, go home, take a few painkillers, go to sleep and never wake up again.

Of course, there are varying degrees of symptoms that can be detectible, but are often misinterpreted (especially by laypeople) as something less serious and next thing you know it's the whole bells and whistles of a really serious situation where the shit has already hit the fan.

I'm glad you didn't get hurt, but banging your head into things is not something to take too lightly or frivolously.
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Re: Obama's Health Care Reform A Failure

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Sea Skimmer wrote:
Rogue 9 wrote:I have to say that even during the period when I was completely uninsured, if I walked into a doctor's office and plunked down cash I would get what I needed. I believe the phenomenon of refusing care to the uninsured exists, but I've never experienced it and don't understand why (presuming demonstrated ability to pay) it is so.
Simple stuff wont normally be refused if you have cash, but you you have any idea how much even the most trivial surgery, let alone cancer or heat disease treatment costs? Anybody with the cash to pay for that would have insurance in the first place. Also the US system simply gives hospitals the right to simply refuse to treat anything which is non emergency even if you can pay, and non emergency is basically anything that wont cause you to die within hours.
True, but a tetanus booster is "simple stuff."
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Re: Obama's Health Care Reform A Failure

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Rogue 9 wrote: True, but a tetanus booster is "simple stuff."
I guess. The problem with injections becomes liability, what happens if the patient has an adverse reaction and needs to go to the hospital? That could cost 100,000 dollars, really easily, and lead to lawsuits in all directions, so if you don't have insurance they just don't want to touch you will any needle. Of course if the US was less lawsuit friendly the price of all health care would be much lower but you talk about reform on that and people rave that this will take away all abilities to punish the bad people for trying to help you. In PA the situation is so bad thanks to a total and utter lack of even the most common sense reform its now typical for a general practitioner to spend 250,000 dollars a year on malpractice insurance, and any kind of specialist is pushing pushed toward the 1 million mark. When I needed to see a cardiologist for a heart murmur years ago the situation was already so bad that my insurance told me look, this isn’t an emergency so you can’t see anyone in the state of Pennsylvania. Luckily I lived close to the border with Delaware so going out of state was not a huge deal, but it was still an extra 45 minute drive when I had a dozen major hospitals and likely hundreds of independent doctors offices within a 10 mile radius. The problem with healthcare reform remains and always was that simply going after the insurance industry is not enough. The lawyers and the pharmaceutical companies need to be part of any solution.
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Re: Obama's Health Care Reform A Failure

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Well, I live in the same state as Broomstick, and while I was uninsured I could just walk into the dentist's office, get three cavities filled (on the wisdom teeth, no less; it was cheaper than having them removed, which I have since done now that I'm insured), pay less than $300, and not even have to do it up front. I'm just lucky, I guess. *Shrug*
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Re: Obama's Health Care Reform A Failure

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It's far more common for people to lack dental insurance than medical insurance, so dentists' offices are more used to cash customers.

My biggest problem was not anything explicit that denied me access while uninsured, it was that so many systems were set up with the assumption that you were insured. It was as much a bureaucratic/computer system barrier as anything else. I encountered more than one location where the computers systems were set up such that they could not bill someone without having insurance information - meaning the operator had to put in "dummy" information to get the system to work at all, and if the person you were dealing with was stupid they'd just say "can't be done".

It's NOT just an "insurance company" problem. True healthcare reform is going to have to deal with the entire system - not just insurance companies (both health and malpractice) but also hospital, doctors, clerks, the people who design the computers used by accounting....
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Re: Obama's Health Care Reform A Failure

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My doctor will also take cash, though I didn't have any major procedures done without insurance. One of my employers during the period provided vaccinations even to part-timers, so that was never a problem.
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Re: Obama's Health Care Reform A Failure

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Edi wrote:If you hit your head hard on something, going to the doctor is a good idea, because it doesn't take a whole lot of blunt force trauma to the head to cause cerebral hemorrhage or something like that which doesn't have any symptoms to begin with but kills you really fucking dead in short order if you don't get treatment straight away. The typical way it happens, you hit your head, figure nothing happened, go home, take a few painkillers, go to sleep and never wake up again.

Of course, there are varying degrees of symptoms that can be detectible, but are often misinterpreted (especially by laypeople) as something less serious and next thing you know it's the whole bells and whistles of a really serious situation where the shit has already hit the fan.

I'm glad you didn't get hurt, but banging your head into things is not something to take too lightly or frivolously.
Well, for a lot of people it's a choice between a small risk of death or the guarantee of debt, and potential death doesn't always seem like the worse option. I've known old folks who have not gone to the hospital with chest pains and nausea because even with medicare it would be expensive, especially if it was just indigestion. If I didn't have my grandmother to take care of I likely wouldn't go to the hospital with a head injury. I probably wouldn't die, and I don't really want to see the world in thirty or forty years anyway.

It may be hard for people living in civilized countries to understand, but sometimes not seeking medical attention is the rational choice.
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Re: Obama's Health Care Reform A Failure

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Broomstick wrote:It's far more common for people to lack dental insurance than medical insurance, so dentists' offices are more used to cash customers.
For most people, your only dental expenses are your biannual cleanings, and the cash cost of those often is less than a year of dental insurance premiums.

I've often wondered why dentists aren't considered as just another specialist. Then I realize that if you have decent dental insurance, you incur no additional cost for your biannual cleanings; if dental procedures were covered under medical, you'd probably have copays apply to your cleanings.

My dental insurance (Guardian) is kind of annoying, since they don't pay my dentist directly for some reason. Are other dental insurers like this? I've never had to be the middleman before.
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Re: Obama's Health Care Reform A Failure

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Edi wrote:For comparison, Elheru, if that happened to me and I went to a PRIVATE FOR PROFIT practice, I'd get off with less than €400 probably. Including x-rays, doctor's fees, lab fees etc. I posted the incident with the banged up wrist in the healthcare vents thread and it gives some numbers.
A bit late to respond, but I was thinking about this the other day.

400 euro is, what, maybe something like $600 USD? Might be closer to 700. That's still a lot, but that's what you might pay here for this incident... IF you have insurance.

I don't necessarily regret the going to the hospital, I'm aware it was a good thing to do and that head injuries are nothing to kid about with. What I do regret is that I didn't have insurance at the time even though I could've gotten it through my work, and as a result ended up paying around $2000 over the next three years that I honestly couldn't afford.

The problem I have, though, is that a person shouldn't HAVE to have insurance to not worry about the cost of medical treatment in the case of emergencies. To put the cost of my medical treatment into perspective, that was 1/6 of a years' pay for me. If it had been any worse, it could've been as much as half, or even ALL of my yearly income.

This is something that I'm honestly kinda bitter about. Yes, it's difficult to work out a system of health care that pays everybody fairly for what they've done for the patient. But, that's far better than a system in which a person without insurance (sometimes even with insurance) risks bankruptcy if they have to go to the emergency room, wait hours, see a doctor for five minutes, get X-rays, whatever, and be slapped with a bill for a sizeable portion of their earnings.

Health care in the United States is shit as far as the finances go, no matter what some people's experience is. Not everybody can afford to put down $300 and get their teeth out, or even $100 for a shot. Not everybody can afford to pay for insurance; mine eats about half my current paycheck, and if it wasn't for my wife's job, we'd be on welfare even though I work. Something has to give, sooner or later, and I just hope to God that something isn't me and my wife moving to Canada.
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Re: Obama's Health Care Reform A Failure

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Rogue 9 wrote:I have to say that even during the period when I was completely uninsured, if I walked into a doctor's office and plunked down cash I would get what I needed. I believe the phenomenon of refusing care to the uninsured exists, but I've never experienced it and don't understand why (presuming demonstrated ability to pay) it is so.
I went to my doctor a few weeks ago, and discovered they no longer accept the only insurance I can get. They were not happy to see me, even though I cash paid. I was essentially grandfathered in because I was an existing patient. They would not accept uninsured new patients at all.
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