Obamacare

Yesterday The Huffington Post ran a story extolling the virtues of Obamacare once again, and crowing in victory that a whopping 4 million people, according to the White House, signed up. http://www.huffingtonpost.com/2014/02/25/obamacare-enrollment_n_4855954.html  Oh frabjous day, calloo callay!

There's a problem here (as indicated by my sarcastic 'Jabberwocky' quote)-- 40 million needed to sign up by now for the program to be solvent. I thought medicare was bad, at least it started out solvent, and just got screwed up later.  Obamacare is starting off in the red.  Not good.  Also, is that enrollment in the website, or actual insurance purchases? The White House has been releasing healthcare.gov account signup figures as 'obamacare enrollment' (aka insurance purchases), not the actual insurance purchases. Just setting up a login on healthcare.gov and throwing a policy in your cart doesn't do anyone any good, neither me as a taxpayer, nor them as a prospective insurance purchaser.  That's like Amazon saying that 500 people bought a given vacuum cleaner, when only 4 people actually finished checking out, and 496 people looked at it, put it in the cart, checked their bank balance, and left the site after realizing they can't afford it.

This article from Forbes discusses some of the root problems with Obamacare:

http://www.forbes.com/sites/realspin/2013/08/21/obamacare-is-really-really-bad-for-you-especially-if-youre-young/ 
Note the use of the word 'risk' throughout the article. Insurance has never been about health care pre-payment-- originally, the way it was supposed to work was, you were basically betting with the insurance company that you wouldn't get sick (with a lower premium if that was a better bet, or a higher one if it was a worse bet), and if you lost that bet, they'd cover your care. Over the years, it's turned into a sort of pre-pay scheme, but was still linked to risk. This takes away the risk, without making insurance a true pre-payment plan. That's just one of the fundamental flaws of Obamacare.


A better way of fixing healthcare/health insurance (BTW, I hate how those 2 completely different concepts have been conflated) is through tort reform (aka medical malpractice (and generally, civil lawsuit) reform), and allowing insurance companies to truly compete across state lines. Right now, there's NO competition between insurance companies across state lines (as an example, SC might have awesome, dirt-cheap policies, but I live in NC so I'm stuck with the NC-only offerings), so there's a bit of a monopoly being forced by the states. Monopoly = lower quality products for higher prices.... economics 101. Competition = higher quality products for lower prices.

With tort reform, you'd be limited in how much you could get in a malpractice case relative to the cost of care (either fixing the problem, and/or ongoing care after the doctor screwed up), which would mean doctors have to carry FAR less malpractice insurance than they currently do. Right now, doctors have to carry millions of dollars in malpractice insurance, which ups their cost to treat patients, which means they have to charge more to treat patients so they can cover their costs. You'd probably be shocked to know how little most doctors (especially private practice doctors) actually keep as take-home pay. Plus, a lot of the cost of care through extra tests and such is due to the fear of a malpractice lawsuit-- so you're getting charged extra for pointless CYA.

Oh, and speaking of paperwork, another thing that drives up health care costs (and therefore directly impacts health insurance costs) is using insurance to pay for everything. Next time you go to the doctor, look at how many staff members are sitting behind the counter filling out paperwork. Doctors have to pay their salaries, and odds are there's more hours spent doing paperwork for filing against private insurance/medicare/medicaid than there are spent treating patients. Time is money. So your $200 doctor visit (or $200/mo insurance premium) is paying that small army of medical assistants to fill out paperwork. Obamacare has actually made that worse by adding tens of thousands of new billing codes that people have to be trained on, and spend time looking up when they fill out that paperwork. BTW, I paid out of pocket for years, and it was cheaper for me to do that than to have insurance. Most offices charge around $70 for cash patients. Generic meds cost $4-15 usually. For the average healthy person, it's nothing to pay that (even working for Walmart like I did) once every couple years. But back to my point, if we reformed the insurance market (through more competition, not top-down government control) and reformed the civil legal system, costs could be brought down to the point that people go back to paying for your average "I have a sinus infection" doctor's visit, and just carry catastrophic and hospitalization (what health insurance originally was) for when you get backed over by a bus.  One other thing that would lower costs is overhauling medical billing and coding.  That's a whole specialization within the medical field in and of itself, and for good reason-- there's tens, if not hundreds, of thousands of billing codes for insurance.  Those billing codes have to be filed just right for insurance to pay properly... picking between emergency blood work, checkup blood work, and office visit blood work (for example) is the difference between insurance paying (for someone who hasn't hit their deductible yet) 0%, 100%, and 60% respectively.  For a $400 blood panel, that's a huge difference.  But that adds more cost, in personnel (or hiring a medical billing and coding company), time, and the added time, cost, and frustration of refiling insurance multiple times until you get the code right.

One thing everyone gets wrong about pre-existing conditions: before Obamacare, preexisting conditions wouldn't keep you from getting insurance. From day 1 of your insurance policy, everything would be covered that wasn't directly related to the condition. After a 6-18 month wait (depending on the terms of the policy) the preexisting condition would be covered. Your premium would be higher, but if you're already sick, you're at a higher risk of getting sick, so again, in a risk-based system a higher premium makes sense. You could have a lower premium by opting to exclude the condition altogether. Obamacare just eliminates the waiting period, and again, takes 'risk' out of the equation for the premium cost calculation.  What about children born with a health problem, you may ask. Well, if the parents don't switch insurance plans, they're always covered. If they do, just like an older child or adult with a chronic illness... pay out of pocket for 6-18mo.  "But what about dealing with how expensive neonatal or pediatric hospital care is, if they're stuck paying out of pocket?" Well, for astronomical medical bills, there is/was already a private solution-- charity care that covers the bills, or charity hospitals that don't charge.  This is especially true of children's hospitals, for that reason.  If you want to go the government route, there's always SCHIP and Medicaid, which children automatically qualify for, regardless of the parents' income and insurance status.  "What about when the kids hit the lifetime cap, and Medicaid/SCHIP don't cover all costs?"  This is why, as is the case for anything else you buy, you shop around. Don't buy crappy insurance if the terms screw you. And employer-provided insurance is not always your best deal.  In fact, buying your own insurance has the advantage of being job-independent.

There is so much wrong with Obamacare, I don't think it can be fixed.  It's not just 'buggy'.  It's fundamentally flawed, and doesn't solve any problems while creating more.