February 5, 2017

T: Did you see this, John?

th-24-copyJ: I hadn’t seen that, thanks. The land mine in there is the repeal of the provision limiting the amount carriers can charge older people. The AARP will be all over that one. The repeal of the individual and employer mandates is important too, as that will tend to drive healthy people out of the market. At least it’s a plan, which is more than can be said for what we had seen before.

T: One thing that jumped out at me was how they are carefully extracting themselves from the pre-existing conditions exemption.
J: I can understand the logic behind that; they want to discourage people from running out and getting insurance only when they get sick. If they’ve been covered all along the repeal of the exemption wouldn’t apply to them. But carriers could charge whatever the market would bear for older people.

T: I don’t dispute your first point – people can’t buy insurance after the fact, any more than they can by flight insurance online from the smoking crater – but I’m looking at it from the insurance company side. The thought I had was that if someone gets sick without already being covered, or has even a temporary lapse in coverage, that person is screwed from now on.

The GOP wants to get back to the standard “fuck you, sick person” model. The “we only cover healthy people” model. Anyone with auto insurance knows the drill. They keep you as long as you never need them, but the first time you need them they dump you like you are radioactive.

You highlighted the potential land mine in your first statement. Young people won’t be required to sign up, so they won’t. The ones who come down with serious conditions won’t be able to get the help any random inmate would get, because they will have a record of interrupted coverage – even if they were currently in the system.

As far as I can tell this is intentional; the insurance companies are setting financial land mines for future generations, so they never have to treat catastrophic illnesses. It’s a slick way to fuck us without us knowing we are being fucked until it’s far too late.

Anyone over the age of 2 needs to get coverage and keep it, and if you are under 2 you better pray Danny Thomas doesn’t have you on speed dial.

J: I understand that health insurance is expensive, and that’s only gonna get worse if the ACA is repealed. We need single-payor in this country.

T: Young people say “we don’t need it, why should we buy it?” and they have a point. But, like you said, if a young person gets sick and they haven’t been in the system, they are fucked harder than Jenna Jameson trying to get out of a parking ticket. The way the suggested law is written, they could be in the system but had a past interruption and they would be disqualified. It’s basically a grandfather clause for all who are currently in the system, but a big middle finger to everyone who comes later, misses a payment, or has an insurance company evil enough to “accidentally” lose a check for a couple of days – just long enough to interrupt coverage.

J: Yeah, and people between 26 and 40 or so are really going to be screwed.

th-23-copyT: And – as you say – anybody older than 40 who isn’t in the system will have one hell of a time getting in once this all shakes out.

J: I don’t think they’d play games with people’s premiums, but I could see them stiffening eligibility rules and coverage rules, requiring you to have been in the system for a certain time before they’d pay for catastrophic illness.

T: If the insurance companies are allowed to do that – to manipulate interruptions in coverage, if only for a day or two – the system will collapse under all the lawsuits. And people will die.

J: Insurance companies have a right to make a profit, of course. They shouldn’t be required to insure someone who shows up after they get sick, expecting full care.

T: Oh, of course. We are all going to have to understand that good medical care is really expensive. Nobody gets a free lunch; it all has to be paid for. Somebody always pays for it.

J: It is fucking expensive, but it doesn’t have to be, at least not as expensive as it is. All European countries have single-payor systems, and their per-patient costs are from one-third to one-half less than the same services here in the US. That’s because there ARE no private insurers; the government controls everything, and it negotiates prices with drug companies and salaries with doctors.

T: Remember my cake model?

Terry’s Cake Model: If you leave a cake on the counter unprotected, it will eventually be gone. It’s a process not dissimilar to anaerobic respiration where organisms eat anything that doesn’t move – until it’s gone. The cake will be eaten, finger by stray fork, until even the crumbs are licked up off the counter.

Any medical billing system that does not specifically prohibit the removal of safeguards against insurance company greed might as well be a cake on the counter.

J: Like I said, insurance companies are in business to make money, and there’s nothing inherently wrong with that; it’s capitalism. However, we’ve reached a point in the system where the only way to continue to increase profitability (and make no mistake, insurers ARE profitable; they just want to be MORE profitable) is to restrict access to care.

They’ll start with the younger people who are less likely to miss it, then gradually creep up the age and sickness scale, licking more and more frosting off the cake.

th-22-copyT: There is a reason why insurance is always so complicated and conflicted. Two sides, both unreasonably greedy because the system is so opaque and convoluted, struggle to find a happy medium between gouging and stealing. There are far too many people in this country who think medical care is free, and that is as big a problem as the inherent sneaky greed of the insurance bureaucracy.

J: It’s not free. Research and development of new drugs isn’t free, doctors don’t work for free,  and those big hospitals don’t just appear magically overnight.

And as much as I’m opposed to socialism in general, there’s one aspect of life in America where it does make sense, and that’s health care. Making money on the backs of the sick, injured and elderly just sticks in my craw.

T: I don’t have a strong opinion about medical coverage. It’s a mess, that’s all I know. The abject poor get good care if they are patient enough to fill out the paperwork, and the incarcerated get good care if they aren’t too fucked up to bother. Rich people get whatever they are willing to pay for, but they pay for it so that’s certainly fair. The two groups that get screwed are the working poor and military veterans – and, as always in our system, the middle class is expected to pay for everything.

J: I deal with the screwing of the middle class every day at work; it’s my job to get the insurance carriers to pay the benefits they’re contractually obligated to pay. You’re right about the working poor; if you’re not poor enough to get Medicaid, you’re going to get forced into a plan with a $6,000 deductible or some shit and God help you if you get sick. And the VA is fucking useless if you really have major health problems, although I’m sure I’m not breaking any news to you on that.

T: Nope. Last time I went to the VA it was so packed that it took me 15 minutes to get to the stairs through the hallways. Ancient mariners pushing walkers everywhere, people stacked in the hallways like firewood … it looked like they moved the zombie apocalypse indoors and made them all wear Vietnam Veteran ball caps.

J: Single-payor is inevitable in the US; it won’t happen until the Democrats have control of all three branches, maybe 2022, but it WILL happen sooner or later.

T: Will it be in time for us? I turn 60 in 2022.

J: I certainly hope so. I suppose the good news, if you want to call it that, is that we’ll hit Medicare eligibility not too long after that, so it won’t be our problem

T: I’m VA, so I get to go be a zombie.

J: By that time all the zombies will be wearing Desert Storm ball caps.