Sunday, March 19, 2017

Wow, I Had Something To Say...

     Alas, then I did a web-search on the differences between ACA and AHCA -- so-called "ObamaCare" and "TrumpCare," despite both sets of legislation largely having been drafted by insurance-company lobbyists and Congressional staffers -- and it turns out that so much as dipping a toe in that pool is like erasing your brain, even if you don't look at the comments.

     They're different to one another.  You will be unsurprised to learn that they both stink on ice.  Oh, slightly different aromas, give them that much, but both have more stick than carrot; both punish people for not having insurance. 

     And here's some secret knowledge: all systems of paying for and providing healthcare suck; all of them suck worse if you're poor and none of them are especially bad if you're rich.  There is no happy, Disney-movie solution and on many levels, the more lawmakers mess with it, the worse it gets.

     Before all this started, if you were poor and didn't have insurance, you were perfectly free to die in a ditch; if you chose not to, showing up at a hospital emergency room would get you treatment (hospitals are generally not allowed to turn away anyone who is genuinely ill or injured) and a whopping huge bill.  Under ACA, you could also die in a ditch or walk into a hospital uninsured, but you were going to be fined in addition to the big bill;* under ACHA, the uninsured get the same two choices and skip the fine, but if they choose the hospital and survive to buy insurance they will pay a 30% surcharge on their premiums -- and so will you, if you go more than two months without insurance.  This is all very interesting, but if the initial aim was to reduce the number of uninsured citizens who die in ditches, exactly how does either plan accomplish that goal?  They don't, no more than a low-flow showerhead in Seattle or Indianapolis helps droughts in California or a shrinking fossil aquifer in Arizona.

     The line I keep hearing is that "everyone has to be insured so the risk pool is large enough," which will come as a surprise to the statisticians and actuaries who work for insurance companies.  It does not take a huge pool to make the risk usefully predictable and there's a lower limit to the rule that adding more people makes the risk more predictable and therefore allows reducing the amount of "just in case" money the insurer needs to keep for off-the-prediction surprises: you do have to pay all those mathematicians, adjusters, attorneys, salesmen, managers, top brass and support staff -- and the investors are hoping for a little profit on the money they have put up to get the whole thing rolling, too.  The thing people seem to think they are saying boils down to "if everyone pitched in a dollar, we'd all be able to afford healthcare when we needed it," a charming sentiment that skips blissfully over what right the rest of us have to demand a dollar from every random stranger.

     I don't have any answers or magic plans; look around the world and all healthcare systems have downsides, some obvious and others very subtle.  "Regulatory capture" is a huge pitfall for any plan and some of the single-payer systems are Klein-bottle examples of it.  On the other hand, any system -- private insurance, single-payer or mixed -- is demonstrably better than none at all.

     Just don't look for any fairy-tale fixes.  There are none.  The basic plan is and will always be, "don't get sick."  It never works out quite that way but the closer you get to it, the better off you will be.

     Some sources, by no means unbiased: The LA Times and The Telegraph.
* The fine is (if I remember correctly) under $2500, which is just about big enough to be insulting and for the the person without two dimes to rub together, might as wlll be $25,000 or $250,000.


Jerry said...

Hi Roberta,

Hate to be the spelling Nazi but it's Sphygmomanometer. I only know because I use the things to test brake systems. It can find a hair under a wheel cylinder cup.


Anonymous said...

Yup, you are indeed correct, what the Rs are offering is a new flavor of the ACA.

That's not gonna end well when folks figure that out.

Next, I expect them to offer a 'solution'. A stout tax on the employed for 'basic health care', AKA a modern single-payer that everyone will have access to, but will never get to actually get, since bloody few doctors will accept the pittance the government pays.

We already are a multi-tiered healthcare system, those with money get seen immediately, those who don't will be in waiting room hell of weeks to months wait for appointments.

Stock up on your favorite popcorn or other roughage snack, things will get ugly in the near future...

New Jovian Thunderbolt said...