Friday, July 22, 2016

Obamacare's Other Success, Under Threat - Bloomberg View

Obamacare's Other Success, Under Threat - Bloomberg View

Comment by Don McCanne

The majority of
Americans believe that everyone should have the health care that they
need when they need it, and that we need a financing system that will
pay for it. Others believe that they should take care of their own
health care needs and not be required to pay into a risk pool that
covers the health care of others. So should the health insurance system
provide comprehensive coverage for all, or should it allow individuals
to purchase coverage for only those benefits they perceive they might

“As a man, why should I have to pay for
maternity benefits I’ll never use?” “As a woman, why should I have to
pay for treatment of prostate cancer - a disease that I’ll never have?”
“I take good care of myself; why should I have to pay for care of
disorders of others due to their smoking, illicit drug use, reckless
driving, sexual promiscuity or whatever?” “I’m healthy so why can’t I
wait until I will likely need health care instead of wasting money on
insurance now?”

“I want to take care of myself
by buying only the insurance I need now, and everyone else can buy
whatever they feel they need.” But what about that unexpected disorder
that racks up medical bills of $350,000? “Well, I didn’t mean that.
Nobody can pay those bills, so the government should pay it instead.”

we’re divided between “we’re all in this together” and “I’ll take care
of myself, and you’re on your own.” But medical care doesn’t work that
way. The twenty percent of people who use eighty percent of health care
are reliant on pooled funds to pay for their health care. Most of the
eighty percent who are relatively healthy will someday shift into the
high health care needs group and likewise also be dependent on pooled

Although the Affordable Care Act was a
step forward in pooling health care risk, there is a campaign to move us
in the other direction. An effort to shut down inadequate plans was
reversed by the Supreme Court, even though those plans will unfairly
shift costs to others when they do not adequately cover expensive
diseases and injuries. Also many politicians want to ensure that people
will be able to “buy only the insurance they need” through gimmicks such
as private insurance exchanges offering the choice of low benefit
plans, purchases out of state to avoid regulatory oversight of insurers,
reliance on health savings accounts - usually underfunded, etc.

a group, those individuals who want to take care of themselves include
many individuals who will have high medical expenses. Whatever way they
set funds aside - spartan insurance plans, health savings accounts,
personal savings - collectively they will not have enough funds set
aside to pay for the expensive care some members of their group will
need. Besides, they have fragmented much of their funds such that only a
limited amount would be available for others, largely through
catastrophic plans that have intolerably high deductibles. Whereas those
of us who support universal pooling of risk would cover our costs
equitably, those who are on their own will dump costs onto the rest of
us through taxes we pay for public programs or through higher medical
bills due to shifting to us the costs of care provided to those who do
not pay their bills.

When people sign up for
Medicare, they do not ask for only the Medicare that they need. They
expect that they will get essentially the same Medicare that everyone
else has (though some may receive similar benefits through the private
Medicare Advantage plans). It should be that way not for just Medicare
beneficiaries, but for everyone. We should improve Medicare and then
make it universal. That will satisfy the majority of us who believe that
we are all in this together, and for those who want to be on their own,
they will accept the benefits of a Medicare for all program just as
they now accept Medicare in their retirement years. Also, they will have
paid in their equitable share, based on ability, just like the rest of

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