Bill was right: it’s a crazy system (part I of II)

By Nathaniel Smith, Columnist, The Times

nsmithcollogoBill Clinton was right about health insurance when he controversially said on October 3:

“…The people that are getting killed in this deal are small business people and individuals who make just a little too much to get any of these subsidies. Why? Because they’re not organized, they don’t have any bargaining power with insurance companies, and they’re getting whacked.

“So you’ve got this crazy system where all of the sudden 25 million more people have health care, and then the people are out there busting it, sometimes 60 hours a week, wind up with their premiums doubled and their coverage cut in half. It’s the craziest thing in the world.”

Obviously, Bill the policy wonk was getting worked up, as you can see from the video of his remarks. And there’s a reason. He and Hillary have been trying to solve this country’s health insurance problem for 20+ years and meanwhile many Americans’ health is still jeopardized by lack of proper medical care and insurance. This is not a theoretical problem. Consequences for individuals range from illness and inconvenience up to loss of homes and death; consequences for society include the current scandal of maternal mortality in Texas and the possible spread of wide-spread preventable epidemics.

Pennsylvania’s recent experience shows why health should not depend on politics.

When Republican governor Corbett came into office in 2011, he abolished Pennsylvania’s then ten-year-old Adult Basic Care program (which was supposed to be supported out of tobacco settlement funds). In return for a small monthly payment, ABC had provided insurance for over 40,000 working low-income Pennsylvanians. By 2014 (if they were still alive) such recipients would have qualified for expanded Medicaid under Obamacare… except that Governor Corbett put in a less beneficial “demonstration” plan. After taking office in 2015, current Governor Wolf realigned the state with the full expanded Medicare program that most but not all states are now part of. And next? Who knows?

Maybe “crazy” was not the most diplomatic word for Bill to use, and he applied it only to people who pay more for less good insurance coverage as they work harder, but “crazy” seems pretty accurate for our whole system today.

Is health care a human right or isn’t it? If not, then we just get used to people unnecessarily spreading infectious diseases (as in antibiotic-resistant tuberculosis), overwhelming emergency rooms, and dying of curable diseases.

But if health care is a right, then everyone should have it without being jerked around by the politics du jour of their state and the country.

If everyone should have health care, it should be a national system. While members of Congress (who, ironically, are among the millions who pay for their own health coverage through Obamacare if they are not covered by Medicare or another program) wrangle and the courts spin their wheels, people in other developed countries go to the doctor and get treated affordably and without surprises because people there have a right to treatment.

Our country’s piecemeal system is indeed crazy. You get health insurance through your current or former job, or through a spouse or parent, or by buying it on your own, or by signing up for Obamacare, or by being in the military or a veteran (or often a dependent or survivor), or by being on Medicare or Medicaid, or through the CHIP program for children whose parents’ incomes are not low enough to qualify for Medicaid, and other possibilities. Or more than one of the above. What a maze!

And then you pay often-changing premiums, copays and deductibles, and different health insurance providers have different networks, doctors and reimbursement levels for procedures, hospitalizations, and drugs.

And (assuming you are good at paperwork and the Internet) you work your way through all that and hope your copay isn’t too big and your “claim” (not a right, notice) isn’t denied. Or if you still don’t have insurance, you go to the emergency room, where they have to treat you anyhow at the hospital’s and everyone else’s expense.

So what’s to be done? Stay tuned.


Part II will appear tomorrow.

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