Truth About Obamacare and How It Solves the Suffering of the Insured

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The Truth About Obamacare and How It Solves the Suffering of the Insured

By Kurt Eichenwald

Let me start by acknowledging: Obamacare is not perfect. Neither is Medicare. Neither is Social Security. Or capitalism. Or your household. Any large system—whether proposed by Republicans or Democrats or any other circus barkers—will have flaws, many of them unfixable, that cause bumps and starts. If we required perfection in all things, we wouldn’t even have a military. Demanding such unrealistic performance is a prescription for overall failure as a nation—as a wiser person than me once said, the great is the enemy of the good.

And we need the good because, fundamentally, the American health-care system stopped working properly long ago. (Unfortunately, this will get a little wonkish—screaming “death panels” and “socialism” is far easier than explaining medical economics.)

Normally, I would start this discussion by providing chapter-and-verse details about the 47 million men, women, and children who now have the opportunity to obtain health insurance, to live longer and healthier lives, to avoid needless bankruptcies. But, in what to me is one of the saddest developments in our nation’s history, that reality is irrelevant to ardent Obamacare opponents. Words like “takers” and “slackers” are thrown at the uninsured, as if they have brought their pre-existing conditions, jobs without benefits, or low-paying positions on themselves. One Tea Party type I spoke with actually said the way to solve the health-care problem would be for the lazy uninsured just to take jobs that provide insurance benefits—as if there were tens of millions of such employment opportunities out there, unfilled. It’s the kind of simplistic answer that allows for the willfully blind to ignore the realities of the uninsured.

But enough. I’ll address the difficulties of the uninsured further down. These days, I have to start by answering the question “What’s in it for me?” (One side note: I’ve always wondered how many of the commenters who criticize my pieces ever actually read them. So, will all critics please type the phrase “I think you’re wrong” at the beginning of your comment? Let’s see how many do.)

The first thing to understand is that when people don’t have insurance, it hurts other people with insurance. In fact, the uninsured affect the finances, quality of care, and availability of medical assistance to every person in a community, regardless of their insurance status.

This is the fundamental issue that too many people do not understand. There seems to be this belief among some that those who are uninsured simply go off and die somewhere, thus having no impact on the medical-care-delivery system in the United States. But the opposite is true—the uninsured have some of the most dramatic effects of any group on our nation’s health-care system.

Here’s why: they seek out care, but usually when their once easily treated conditions have blossomed into a serious illness. Because private doctors do not take them, and because free clinics are not readily available, the uninsured seek their care in emergency rooms.

To some Republicans, that’s just fine. During the 2012 campaign, Mitt Romney burbled happily about how the uninsured could simply go to emergency rooms for health care. So did George W. Bush in 2007, when he stated, “People have access to health care in America. After all, you just go to an emergency room.”

I’m not sure if the folks pushing this line are trying to deceive their listeners or actually don’t understand the impact of what they are suggesting. Here is reality, spelled out simply in a report issued by the Task Force on Access to Health Care in Texas, which is composed of major health-care providers, businesspeople, medical economists, and other experts—folks who, unlike politicians, actually know what they are talking about when it comes to this topic. It states:

The uninsured are often unable to pay for medical services they receive. These expenses are passed on to others through higher medical fees and insurance premiums.Since many uninsured and underinsured individuals obtain primary care at emergency rooms, they risk overburdening of the local trauma system. This impacts the finances and ability of emergency rooms to handle trauma. The overuse of an emergency department can even lead to increased local taxes.

In other words, when people complain that they don’t want to be subsidizing “freeloaders” through Obamacare, they don’t understand that they are already paying for the care of the uninsured. And these are not small amounts. In fact, since emergency rooms are the most expensive forms of front-line care, the cost is very high, far more than the cost of a visit to a doctor’s office.

[Wahalla]

got a question.....

Does the so Call Obama care mean every one has health care when they require it ????? Both preventative and emergency ????

[blugiant]

part 2
How much are we talking about? Well, I can actually give you the real numbers, at least as they existed about a decade ago, the last time this type of study was conducted. Remember, since then the number of uninsured has gone up and the average annual inflation rate for health care over the past decade has been about 3.7 percent, so these numbers should be at least 30 percent higher.

According to the 2005 study, by Families USA, a national nonprofit organization that conducts research on health care, the uninsured pay more than one-third of their total medical bills to emergency rooms and other medical facilities. (Before someone snarls, “Make them pay all of it,” I think I need to toss out that old cliché, you can’t get blood from a stone.) That leaves about $43 billion that goes uncompensated. But hospitals can’t suck up those kinds of losses without closing, so that amount is paid for by taxes and increases in insurance-policy premiums. That’s right—your taxes and your insurance-policy premiums are already paying for the uninsured.



Generalizations might be hard to understand, so let’s talk dollars and cents. In 2005, increased costs of premiums due to uncompensated care from the uninsured being passed on by increased health-care prices averaged $922 for families with insurance provided by their jobs. For people with employer-provided insurance, that number was $341.

But remember, those are national averages. The increases in premiums caused by passing on the costs for the uninsured are highest, of course, in states with the highest numbers of uninsured. And those are among the states fighting the hardest against providing insurance through Obamacare.



Take Texas: the average increase of premium costs caused by uncompensated care for the uninsured in an employer-provided policy for a family was $1,551 in 2005. In Montana, $1,578. Alaska, $1,446. Idaho, $1,432. North Carolina, $1,130.

Now, there are other states where residents are paying more in added premiums—in excess of $1,700 for families in New Mexico, West Virginia, and Oklahoma—but I selected the first five states I mentioned to make a broader point. Each of those states is among those that have rejected an expansion of Medicaid under Obamacare that would be financed by the federal government. In other words, in some twisted, illogical idea of protecting their citizens, they are keeping their policy costs *higher while simultaneously denying less-expensive medical care to people who are not poor enough to qualify for Medicaid now. The whole idea has never made any sense to me—why would a politician choose to force their citizens to pay more? But I have a strong feeling that there are not a lot of state legislators or governors who understand this basic concept of medical economics.

Again, those are the solid numbers, reported in 2005 based on 2005 data. But Families USA also ran medical billings through a health-cost-inflation model, which allowed them to predict the value of the additional premiums that would be paid by Americans to cover care for the uninsured in 2010. And those numbers are uglier. On average nationwide, uncompensated care resulting in higher medical costs added $1,502 to premiums for families relying on employer-provided policies—from a total amount that had gone unpaid in excess of $60 billion. And once again it is the citizens of states most opposed to Obamacare who are refusing expansions of Medicaid who are taking the biggest shellacking: Texas residents are paying $2,786 more in premiums for family policies provided through employers. Montana, $2,190. Alaska, $2,248. Idaho, $2,152. North Carolina, $1,828. The other states I mention also take big hits—New Mexico, West Virginia, and Oklahoma residents are all paying about $3,000 more for premiums on employee-provided policies.

Ugly, ugly stuff. And don’t forget, this does not include the increase in local taxes that goes toward paying the remaining portion of the bill for the uninsured.

How, you may wonder, do the subsidies that Obamacare provides to the folks unable to afford insurance on their own compare with those numbers? Well, remember, in 2005, the total amount of uncompensated care that had to be covered by taxpayers and the insured was $43 billion; in 2014, the Congressional Budget Office estimates that total exchange subsidies will be $35 billion. In 2010, the estimate of total uncompensated care was in excess of $60 billion; the total amount of subsidies for 2015 is estimated at $62 billion.

But the price paid by the insured because of others’ lack of insurance is not just monetary. In fact—if you have insurance—the more uninsured who live in your community, the lower the quality of care you receive. Again—if more people in your community are uninsured, your care will be worse. In other words, if you want to go to the places with the worst medical care, hightail it to states like Texas that are fighting Obamacare, making it difficult for their residents to figure out how to use the Obamacare insurance exchanges, and refusing to expand Medicaid. The insured folks in that state will get worse care than one with more people insured.

Before quoting anyone on that, follow the logic. Hospitals don’t have poverty wards; if a patient comes in the door in bad shape, they don’t do a wallet biopsy before deciding what care that person should receive—everyone at a hospital receives the same quality. But if a community has a higher number of uninsured, that means the latest and greatest technology and treatments will drive up the amounts of unreimbursed care. In essence, hospitals that provide the best, most modern, and most expensive treatments in an area with lots of uninsured will be forced to pass unsustainable amounts of cost to their prices. Insurance companies won’t pay it, local governments won’t finance it, and the hospitals will go out of business.

The only option then? Don’t provide the top-quality care to anyone—insured or not. That keeps the cost of uncompensated care down and lets the hospital stay in business.

This is not something I have just dreamed up. Repeated studies over the past decade have showed a consistent relationship between the number of uninsured in an area and the quality of care available for all residents there. To cite one example, the Institute of Medicine in the 2009 report “America’s Uninsured Crisis: Consequences for Health and Health Care” states:

When a community has a high rate of uninsurance and subsidies fall short of costs, the financial impact on health care providers may be large enough to affect the availability and quality of local health care services, even for people who are insured.

Not persuasive enough? Then let’s quote a study from two of the best-known experts in this area of health-economics research, Mark Pauly of the Wharton Business School and Jose Pagán of the University of North Texas Health Science Center. In one of their several extensive reports on this question, they write:

There are substantial spillover effects of community uninsurance on the access to—and satisfaction with—health care for the privately insured population. . . Providers will note that, if they must provide the same quality level to insured and uninsured customers, increasing quality increases the losses they suffer from charity care since higher quality care has a higher cost, and that higher cost is not being covered for the uninsured patients.

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part 3

And the impact of the uninsured on the health care of the insured is not limited to the types of treatments and quality of care available. Given that so many of the uninsured wait until they are in horrible condition before heading to the emergency rooms, those facilities are often swamped with patients, leading sometimes to unsafe situations. As the American College of Emergency Physicians reports:

Many of the uninsured people who arrive in America’s hospital emergency departments are in terrible shape. Emergency physicians say they have delayed needed care, live with more serious medical conditions and are more likely to die before their time than those with health insurance. Dangerous overcrowding is caused when a lack of hospital resources results in acutely ill patients being “boarded” in an emergency department, because no hospital inpatient beds are available, and ambulances must be diverted to other hospitals.

When I tried to explain this to one of my Tea Party friends, she offered up the retort that, well, the uninsured shouldn’t try to make things so easy on themselves by going to the nearest hospital and be forced to head farther away for clinics. Again, a simplistic retort that does not recognize reality, which was neatly summed up by the Rand Corporation, when it reported that “most ambulatory patients do not use EDs [emergency departments] for the sake of convenience. Rather, they seek care in EDs because they perceive no viable alternative exists.”

So, without even thinking about the wellbeing of the uninsured, why should other Americans care about them? Because they make life worse for those with insurance—the insured pay more and receive worse care than they would if the uninsured were covered. It’s that simple. That is the major problem that Obamacare is meant to solve.

With the “what’s in it for me” question regarding the benefits of covering the uninsured, now let’s go to the price they pay for being without health insurance. This one is as simple as screaming “death panels”: the uninsured die. As the Texas health-care task force reports:

Overall, the uninsured receive less preventive care, are diagnosed at more advanced stages of disease, and once diagnosed, receive less therapeutic care than do the insured. Thus, lack of adequate insurance leads to premature death.

Hopefully, those words are easy enough for everyone to understand. If Republicans truly are dedicated to the sanctity of life, they should be the first ones on the front lines trying to get policies for the uninsured.

And who are these uninsured, these people dismissed by too many Tea Partiers as lazy takers? Once again reality is more complicated than some people want to believe—80 percent are in working families that cannot afford insurance and, largely because of their jobs, are not poor enough to qualify for government assistance. About 20 percent are children. Maybe it is still easy for some to sneer at the uninsured, but from the statistics what I am seeing is that the vast, vast majority of them are hard-working Americans who simply do not have the same salary and benefit opportunities that others might. And again, no, there are not tens of millions of higher-paying jobs with benefits sitting out there unfilled.

Now, Obamacare is able to allow for a lot of different benefits that go to everyone—currently insured or uninsured—and these are not just gifts. This goes to the heart of what the program does: Obamacare is not socialism; it is not welfare; it is not any of the claims from people who don’t understand medical economics enough—like politicians—to figure out what is happening.

The program is about one thing: changing the risk profile of the insured population. That’s it. The reason that needs to be done is because of everything I have written above—the entire country is paying a huge price because people either don’t, won’t, or can’t purchase health insurance. Whether out of recklessness or simple inability to obtain a policy, the lack of coverage has twisted the health-care industry in ways no one would choose.

So, to make health care work, everyone has to be insured—not just the sick but the healthy as well. The reason is healthy people can’t buy insurance when they get sick, and they stick the rest of us with the bills they rack up. With healthy people insured, that risk to the rest of us is removed. Also because now the profile of the average insured person is healthier, the companies can now afford to sell policies to sicker people. That’s why we can have policies without pre-existing-condition clauses or lifetime caps, and it’s also why under Obamacare you can no longer be dropped from your insurance just because you get sick.

I don’t expect to persuade the people who really believe all the malarkey about death panels and socialism. They have been lied to for so long that I think it will take years before they will be able to understand how badly they have been used. But, hopefully, there are those who want to know why Obamacare exists and what the point of it is. And when you know the truth, you will understand that—for all of its imperfections—Obamacare is an essential step toward healing the deeply sick American health-care system.

http://www.vanityfair.com/online/eichenwald/2013/10/truth-obamacare-already-insured

[blugiant]

got a question.....

Does the so Call Obama care mean every one has health care when they require it ????? Both preventative and emergency ????

no.

a latt aff poor peeps still will natt be insured

dat wan aff da reason y mii doan like itt

mixxed race man usinn buyinn slice aff bread bettar dan natt being able any bread argument even iff slices aff bread cost poor peeps more dan loaf aff bread

[Wahalla]

no.

a latt aff poor peeps still will natt be insured

dat wan aff da reason y mii doan like itt

mixxed race man usinn buyinn slice aff bread bettar dan natt being able any bread argument even iff slices aff bread cost poor peeps more dan loaf aff bread

Got to ask u.... Are u covered ????? Say if ur wife woke one morning and after the usual predawan romp...... noted u had a lump in ur genetialia...... Do u have to pay anything at the hospital for the check up ????? As a teacher I assume that u are averaged waged....I ask just to understand how it works....not to embarass... I used the example as it is non emegency and potentially a very serious though non life threathening....

[kia027]

The first thing to understand is that when people don’t have insurance, it hurts other people with insurance. In fact, the uninsured affect the finances, quality of care, and availability of medical assistance to every person in a community, regardless of their insurance status....

.
.

But the opposite is true—the uninsured have some of the most dramatic effects of any group on our nation’s health-care system.

Here’s why: they seek out care, but usually when their once easily treated conditions have blossomed into a serious illness. Because private doctors do not take them, and because free clinics are not readily available, the uninsured seek their care in emergency rooms.

These expenses are passed on to others through higher medical fees and insurance premiums.Since many uninsured and underinsured individuals obtain primary care at emergency rooms, they risk overburdening of the local trauma system. This impacts the finances and ability of emergency rooms to handle trauma. The overuse of an emergency department can even lead to increased local taxes.

In other words, when people complain that they don’t want to be subsidizing “freeloaders” through Obamacare, they don’t understand that they are already paying for the care of the uninsured.

And these are not small amounts. In fact, since emergency rooms are the most expensive forms of front-line care, the cost is very high, far more than the cost of a visit to a doctor’s office.

Many of the uninsured people who arrive in America’s hospital emergency departments are in terrible shape. Emergency physicians say they have delayed needed care, live with more serious medical conditions and are more likely to die before their time than those with health insurance. Dangerous overcrowding is caused when a lack of hospital resources results in acutely ill patients being “boarded” in an emergency department, because no hospital inpatient beds are available, and ambulances must be diverted to other hospitals.

Obamacare is not socialism; it is not welfare; it is not any of the claims from people who don’t understand medical economics enough—like politicians—to figure out what is happening.

[blugiant]

Got to ask u.... Are u covered ????? Say if ur wife woke one morning and after the usual predawan romp...... noted u had a lump in ur genetialia...... Do u have to pay anything at the hospital for the check up ????? As a teacher I assume that u are averaged waged....I ask just to understand how it works....not to embarass... I used the example as it is non emegency and potentially a very serious though non life threathening....

mii ave great coverage better dan moas ann mii tink evereebadee deserved da same iigh qualitee health insurance like wat mii ave

mii doan like mixxed race man plan cah itt mean a latt aff parents now affii pay fe dem yuths insurance till dem yuth 26. manee peeps ave yuths before dem 26 so oww dat wukk. a latt aff da poor peeps woo will natt be insured ar single blakk mothers ann mii doan tink dat rite. single payer was da best solution ann da mixxed race man sed so imself butt imm dissmissed itt ann push imm flawed varsian aff healthcare fe sum

to mii dat nuh rite ann mii nah defend dat

[kia027]

mii ave great coverage better dan moas ann mii tink evereebadee deserved da same iigh qualitee health insurance like wat mii ave

mii doan like mixxed race man plan cah itt mean a latt aff parents now affii pay fe dem yuths insurance till dem yuth 26. manee peeps ave yuths before dem 26 so oww dat wukk. a latt aff da poor peeps woo will natt be insured ar single blakk mothers ann mii doan tink dat rite. single payer was da best solution ann da mixxed race man sed so imself butt imm dissmissed itt ann push imm flawed varsian aff healthcare fe sum

to mii dat nuh rite ann mii nah defend dat

Emerging adults have the option of being under their parents plan until they are 26. Insurance companies used to automatically remove young adults from the plan. Now they can remain on the plan if that is what the parent wants to do

[lonewolf]

(One side note: I’ve always wondered how many of the commenters who criticize my pieces ever actually read them. So, will all critics please type the phrase “I think you’re wrong” at the beginning of your comment? Let’s see how many do.)

I think you're wrong. There, I said it. Not with the points that he makes, but with the misconception of that, if one is against Obama care, that they are against changes in the US health care system. It's just not true.

The US health care system is broken. It needs to be fixed. Obama care is not the fix. Obama care is broken.

To some Republicans, that’s just fine. During the 2012 campaign, Mitt Romney burbled happily about how the uninsured could simply go to emergency rooms for health care. So did George W. Bush in 2007, when he stated, “People have access to health care in America. After all, you just go to an emergency room.”

Mitt Romney started Obama care in Massachusetts. If anyone knows its flaws and failures, it would be Mitt Romney. The Obama care model is based off of Romney care. It has been tried and it is has failed.

Why put in place a health care system that has been a proven failure?

There has to be a better system...Can you say the health care system in France?

Why not use that as a model? Can anyone argue that point? Why Obama care?

[blugiant]

I think you're wrong. There, I said it. Not with the points that he makes, but with the misconception of that, if one is against Obama care, that they are against changes in the US health care system. It's just not true.

The US health care system is broken. It needs to be fixed. Obama care is not the fix. Obama care is broken.





Mitt Romney started Obama care in Massachusetts. If anyone knows its flaws and failures, it would be Mitt Romney. The Obama care model is based off of Romney care. It has been tried and it is has failed.

Why put in place a health care system that has been a proven failure?

There has to be a better system...Can you say the health care system in France?

Why not use that as a model? Can anyone argue that point? Why Obama care?

da sad ting iss dat awl da politrixxstahs now da solution iss a single payer system fe tekk da profit out aff a healthcare system dat xxploit sick peeps.

obamacare iss based aff aff romneycare but obamacare iss diffarant cah itt include sum fixes dat alter sum aff da issue widd romneycare. yuh kno deer iss diffarances. da reason y dem appose obamacare iss dat republikkans fear itt will improve merikka healthcare system.

seyinn dat mii still agree widd yuh dat obamacare is natt da anwsar. medicare fe awl ar single payer system is da best solution.

[blugiant]

Emerging adults have the option of being under their parents plan until they are 26. Insurance companies used to automatically remove young adults from the plan. Now they can remain on the plan if that is what the parent wants to do

kia yuh doan see dat as shifting more aff da healthcare burden to parents wild enrichinn da healthcare industrees cah peeps undar 26 less likelee fe need insurance.

[My Looh]

The French system places substancial caps on what doctors charge for their serveces. If the French system was SUCCESSFULLY put in place in America it would mean doctors would be earning less than they do now.

How would that go over?

I'm not putting down the idea of the French system (I'm a fan as well), but I'm seriously asking how it would fly if it means that American doctors will have to earn less than what they are accustomed to earning?