Tag Archives: Health Care

Patience and the Affordable Care Act

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It’s always bothered me that the Obama administration didn’t come up with a catchy name for the health insurance provisions of the Affordable Care Act. We’ve got “Social Security”, “Medicare” and “Medicaid”, so why couldn’t the administration come up with an equally helpful name for this thing, instead of leaving an opening for it to be called “Obamacare”?

I bet if Saint Ronald was still President, one of the first things on his agenda would have been to give his pet program a great name that would help sell it to the American people. But Obama apparently thinks he’s above such things.

Nevertheless, the important thing is that this landmark legislation is going into effect two days from now, regardless of what any misguided, foolish, cowardly and/or evil House Republicans do in the meantime.

I know people (including myself) who will probably be taking advantage of the ACA in the relatively near future, so I’ve been wondering how much it’s going to cost. Unfortunately, there are reports in the media that suggest what “average” premiums will be. There was one such unhelpful article in the New York Times today: “‘Affordable Care’ or a Rip-Off?”.

The problem is that you can’t know what a person’s or a family’s costs will be until you factor in where they live, how old they are and, especially, what their income is. Many or most people in this country, not just the poorest among us, will be eligible for subsidies from the government. In fact, if you’re eligible for a subsidy, you won’t even have to wait for the IRS to send you a check. The subsidy will be applied right up front when you pay your insurance premium (which means that some people won’t have to pay anything at all).

There is good news here. The health insurance premiums being discussed so far are generally cheaper than what people would pay for private health insurance today, and the premiums are going to be lower, often much lower, for many of us after the subsidies are applied.

So maybe everyone who’s interested should wait a couple days and then go to https://www.healthcare.gov/ to see the real numbers (and also see the pretty young woman with a big smile on her face). I’m sure we can all wait a couple more days.

Here’s today’s New York Times editorial on the importance of the ACA and the subsidies:

http://www.nytimes.com/2013/09/29/opinion/sunday/dawn-of-a-revolution-in-health-care.html?

If you’re in the mood for even more good news, take a look at this column from Nicholas Kristof. Here’s his conclusion, supported by statistics from the World Bank, the Gates Foundation and the U.S. Agency for International Development:

So let’s acknowledge that there’s plenty of work remaining — and that cycles of poverty in America must be a top priority at home — yet also celebrate a triumph for humanity. The world of extreme poverty and disease that characterized life for most people throughout history may now finally be on its way out.

http://www.nytimes.com/2013/09/29/opinion/sunday/kristof-a-way-of-life-is-ending-thank-goodness.html?

Death and Taxes

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A recent article by Katherine Newman, a sociology professor at Johns Hopkins, highlights the effect of rising tax rates on the poor. She points out that for the past 30 years or so, many states in the South and the West have been raising sales taxes and fees for government services, both of which especially affect the poor. States in the Northeast and Midwest, on the other hand, have generally been more progressive in their tax policies, some even going so far as to create local versions of the federal Earned Income Tax Credit, which is specifically designed to assist people who don’t earn much money.

According to Professor Newman, the result of these policies, after correcting for other variables, like the local poverty rate, racial composition, diet and cost of living, is that there is a clear relationship between taxing the poor and “negative outcomes”, such as heart disease, infant mortality, dropping out of school, divorce, property crime and violent crime:

“The poor of the South — and increasingly the West — do worse because their states tax them more heavily. They have less money to buy medication, so their health problems get worse. High sales taxes make meals more expensive, so they shift to cheaper, unhealthy food. If people can’t make ends meet, they may turn to the underground economy or to crime.”

Partly for this reason, Southern and Western states receive more than their share of the federal budget (it’s not just because they have lots of military bases):

“Medicaid payments, food stamps, disability benefits — all of these federal programs swoop in to try to patch up a frayed safety net. Consequently, the Southern states reap more dollars in federal benefits than they pay in taxes (like Mississippi, which saw a net gain of $240 billion between 1990 and 2009), while the wealthier states — which do more to take care of their own — lose out for every dollar they pay (like New Jersey, which handed over a net of $706 billion over that same period)… We all pay for the damage done when states try to solve their fiscal problems, or score ideological points, on the backs of the poor.”

And yet the situation is getting worse, as states like Louisiana, Nebraska and North Carolina consider cutting income and corporate taxes, while raising sales taxes. 

http://opinionator.blogs.nytimes.com/2013/03/09/in-the-south-and-west-a-tax-on-being-poor/

Electrocardiograms ‘R Us

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I saw my primary care doctor last week. She decided that I needed an EKG. She also personally called my cardiologist’s office and got me an appointment the following day.

When I arrived at the cardiologist’s office, the first thing they wanted to do was an EKG. I pointed out that I had just had one yesterday. The nurse went away, presumably to get a fax of my EKG from my other doctor.

Unfortunately, that’s not what happened. My cardiologist ordered her own EKG.

Both EKG’s were normal. Our insurance company will be billed for two tests, one of which wasn’t necessary.

Paul Krugman points out that the US and Canada used to spend about the same amount on health care, but we don’t anymore. Our system, supposedly based on free market competition (and as many EKG’s as possible?), now costs more than Canada’s, even though the Canadian single-payer system gets better results and Canadians are happy with the health care they receive.

http://krugman.blogs.nytimes.com/2012/08/31/health-systems-and-health-costs/

Romney Tells the Truth. Oops!

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Michael Kinsley once said that a political gaffe is when a politician tells the truth — some obvious truth he isn’t supposed to say. There are other kinds of gaffes, of course, but this kind can be especially informative.

Yesterday, Mitt Romney praised the efficiency of the Israeli health care system. It is efficient, since they spend much less than we do per capita while getting better results and providing universal coverage.

Maybe Romney didn’t realize it, but it’s important to note that the Israeli healthcare system is single-payer and government-regulated. It is, in fact, an example of socialism at its best.

Definitely the kind of political gaffe described by Michael Kinsley.

http://www.forbes.com/sites/rickungar/2012/07/30/whiplash-mitt-romney-lavishes-praise-on-israels-socialist-government-controlled-healthcare-system/

Over There

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Those poor, benighted Brits — celebrating their socialistic National Health Service at the Olympics opening ceremonies!

Don’t they know it would be so much better to have a system like ours?

One that is reliant on profit-driven employers paying as little as possible to profit-driven insurance companies, who pay as little as possible to profit-driven doctors, hospitals and pharmaceutical companies, who charge as much as possible.  

Leaving millions without decent health care, whether or not they have health insurance, while we spend more on healthcare per capita than any other nation in the world and lag behind other developed nations in quality of care.

A system in which people often decide where to live or work depending on whether an employer provides health insurance.  

A system in which a major illness can bankrupt a family.

Crazy foreigners.