A LA CARTE


“Politics is not just about power and money games, politics can be about the improvement of people’s lives, about lessening human suffering in our world and bringing about more peace and more justice.”  Paul Wellstone

I miss Paul Wellstone.  The American Health Care Act (AHCA) was pushed through the House at lightning speed.  Fortunately, House bills don’t go directly to the President.  There is the Senate.  The idea, however, was to get this bill passed, so the representatives could go back to their districts without dealing with angry constituents.

Oh, there will be some angry confrontations to be sure, but unlike the roll out of the Affordable Care Act, there will be no debate at town halls.  Then representative Gabrielle Giffords had raucous ones, including one that ended rather quickly when a firearm fell out of a guy’s pocket.  This was, after all, Arizona.  I’d say that Giffords was shot by Tea Party activists, but that isn’t true, not that the truth matters much in today’s America.  No, she was shot by a mentally ill individual who had access to a gun (another story that is going to likely happen again in today’s America, but I won’t discuss that issue here).  The Tea Party was thrilled, I’m sure, since they have no shame, and they are thrilled that the hated “Obamacare” is again repealed.

It is obvious that the Republicans had no health care plan ready for rollout, or they would have had it on the table 3 January, had it passed and to the Senate on 21 January, if they worked on Saturday, which many of “the little people” do.  This bill was cobbled together with little input from many, including other Republicans, who are likely going to be wrong about the anger of their constituents, since the Senate will not pass this bill as it stands.  There appear to be three groups of Republicans: those who like the bill, those who think it didn’t go far enough, and a small, but important few who think what we had was worth preserving.

There is a lot about the AHCA that I could address, but I will stick to five comments.  First, what people call it is important.  A significant number think Obamacare and the ACA are different, and the Republicans succeeded in making “Obamacare” a hated name.  Shame goes to the Democrats and journalists who bought into that.  Currently, there is some effort to tell us not to label the AHCA “Trumpcare,” which Paul Krugman says we should.  I agree with him, even if I have to use the name.  I prefer Voldemort.

Second, the bill has a mandate that if somebody lets his or her insurance lapse, they must pay a 30% increase in premiums to get covered again.  This mandated tax—let’s call it what it is—will hurt many, those who don’t understand insurance, don’t get, open, or understand their mail, and may throw things out without realizing how important they are.  These very people—and there are many of them— stand to be hurt by an increase in premiums, and I suspect their health is normally not very good.  A lot them are poor, elderly, people of color, uneducated, unemployed or underemployed, who won’t be able to understand their coverage.

Third, the notion of à la carte insurance presupposes people know what medical problems they will have in their lifetime.  I’m a neurologist who trained until he was 32, knew a great deal about disease, and I would not have guessed the things I’ve had that I wouldn’t have suspected.  We don’t know what medical conditions we will have. Individuals don’t have that knowledge, Mr. Ryan. When they get ill, they want help and treatment, not to shop to compare insurance companies and enjoy a “free market” with “competition,” comparing plans in the comfort of their trailer home which isn’t paid for, and may not have food or heat.  People don’t have the knowledge to know what the insurance company is offering and more importantly not offering.  Those Mr. Ryan thinks will benefit from competition won’t, because they can’t understand the complexity of medical care.  No, I don’t want people trying to choose what medical conditions they want to cover. They can’t and shouldn’t.

Finally, catastrophic care should be covered, even if it once failed to pass, because it would have taxed only the elderly.  My late father, the epitome of a rational person, became totally unglued about the Catastrophic Care Act of 1988.  I didn’t dare mention it in his presence. Such conditions strike at any age and are almost by definition unpredictable. The biggest killer of people 15-44 is unintentional injury (read: accidents), double that of suicide, homicide, cardiac disease, and cancer, all of which are about the same.  The common causes of ED visits are fever, otitis media, open wounds, contusions, sprains and strains: 1 in 5 in the ED were not insured (in 2010), and given the heavy use of CT and MRI imaging, injuries are expensive to treat.

À la carte coverage, like insuring oneself for what one thinks he will need, should be banned.  As for those who believe men shouldn’t have to pay for women’s health care, this is a slippery slope for people like me who might say I shouldn’t have to pay for people who don’t eat right, smoke, chew, drink, have guns in their homes, don’t wear seat belts, are overweight, don’t exercise, take recreational drugs, and aren’t vegetarian, for a start.  It doesn’t work. We can vary premiums a little, but when we start treading into areas that people are genetically or physically unable to control, we are asking for trouble.  No, I can never get pregnant, but a woman can’t get prostatitis and has a lower incidence of cardiovascular disease than I do.  As for paying for birth control, I can’t think of many better cost-effective remedies, since fewer unwanted children takes pressure off young families, schools, jobs, and the whole health care system.  We ought to pay women for taking birth control pills and tax men who use anti-ED drugs, since we need fewer sperm floating around.

Finally, we need a single payer system, like the one John Conyers introduced again, as he has since 2003.  This would decrease overhead percentage dramatically, allow for standardization where it matters, require negotiation for drug costs, and track illnesses, treatment, quality, and yes—errors.  A single payer system wouldn’t cover everything, but it would cover what Medicare does.  It wouldn’t cover abortion, but it would cover contraception.  It would cover what is scientifically known and rapidly cover what appears to be known. Insurance companies could sell supplementals with varying deductibles, for those who wish them to cover those conditions not necessarily covered under the standard policy, ED drugs being my favorite for non-coverage, but hey, I’m willing to bargain.

My bottom line: repealing the ACA before knowing how many million would lose coverage  was heartless. People will die because of this bill, should it become law. Long term thinking would say providing medical care to the whole country would save money in the long run and be in keeping with our ideals.

At least the ideals we once had.

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One Response to “A LA CARTE”

  1. denisehelmkay Says:

    Thank you for your insights; they are gaining acknowledgement slowly as people really take their time to understand the details. It is too bad our over inflated orange puff continues to undermine the very foundations of what it means to care about one another. US BABYBOOMERS are taking it in and mulling it over. How much damage will we have to endure before the waste of money flying to Mir Alago every weekend will equal our annual spending for the most needy in our society?

    Denise Helmkay helmkay@aol.com

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