FacebookTwitterRedditEmail

Five Years In – How’s the Affordable Care Act Doing?

Hard to believe it’s been five years since Congress passed the Affordable Care Act (ACA) on March 23, 2010. The bloviating, vein-popping right-wing still goes ballistic at mere mention of the word Obamacare.

Still, putting aside their senseless distortions and diatribes, not too many of us have cause for celebration except perhaps the top brass from the 1300 or so private health insurers who are raking in enormous profits – health care stocks soared by almost 40 percent in 2013, the highest of any sector in the S&P 500.

Nonetheless, as a reminder, the controversial law does contain some important positives for regular folks. For example, it guarantees coverage for everyone without tacking on higher premiums because of pre-existing medical conditions and it requires annual free preventive-care health checks for those on Medicare.

But, five years in, as critics continue to emphasize, ACA still primarily serves as a huge government marketing campaign for private insurance companies, funneling millions of new customers with few if any restrictions on ever-escalating prices.

“The ACA built upon the flaws of our market-based system and, quite predictably, is failing to contain costs and provide broad access to affordable, quality health care. Corporate interests still trump the common good in U.S. health care,” according to a five-year ACA assessment appearing in the Feb. 10, 2015 International Journal of Health Services, authored by M.D. John P. Geyman.

Dr. Geyman is not alone. Other very prominent scholars and caregivers agree that ACA’s reliance on private insurers is its downfall.

For example, the developer of the cardiac defibrillator, Dr. Bernard Lown, completely dismisses their role in providing quality care for the simple fact that “like all businesses, their goal is to make money.”

Get What You Pay For & Nothing More

In essence, we still only get the care we can afford depending on which of the thousands of plans we subscribe.  Ability to pay is still the big problem.

As a result, medical bills remain the number one reason for personal bankruptcy even though most of the petitioners have health insurance. For the rest of us, it’s not much better.

Shockingly, roughly 40 percent of Americans have trouble paying medical bills as noted (on pg. 44) by an extremely detailed 2011 National Scorecard on U.S. Health System Performance commissioned by the Commonwealth Fund.

And, though many have found policies with affordable premiums, the report also indicated that adults are likelier than those in other developed countries to forgo care because of cost.

The statistics are alarming.

In the past five years, according to a thorough 2015 Bloomberg review I will cite extensively, the average price to see a primary care doctor has risen 20 percent. For a specialist it’s gone up 29 percent and for outpatient surgery it’s up 43 percent.

No wonder, the article explains, 22 percent of people now say the cost of getting care has led them to delay treatment for a serious condition. That’s the highest percentage since Gallup started asking in 2001. Another poll cited found as many as 16 million adults with chronic conditions have avoided the doctor because of out-of-pocket costs.

The Problem in a Nutshell

SinglePayer Now! San Francisco organizer Don Bechler, described to me that the multiplicity and complexity of insurance plans are largely designed as “marketing lures to hook more customers.” Plans are tweaked, individualized and adjusted for the particular amount of up-front money each business is willing to put up for employees.

Thus, Bechler explained, to seal the deal and keep premiums coming in, insurers set up a multitude of corporate plans that impose a wide variety of burdens on employees for premium-cost sharing, co-payments and deductibles.

Figuring out the billing for each patient, for each physician and for each care facility among the tremendous diversity of plans, Bechler added, “becomes a nightmare fraught with delays and confusion.”

This was confirmed by a recent study of private insurance Medicare Advantage programs that discovered patients were overcharged around half the time.

So, it’s clear, the bloated bureaucracy that is crippling our healthcare resides in the private sector, not in government.

Waste Is Revenue

In addition, the complexity of plans, each with its own marketing, paperwork, enrollment, premiums, rules and regulations, also contributes to an enormous administrative cost overhead.

I spoke about this with James G. Kahn, M.D., MPH, who is a researcher at the Philip R. Lee Institute of Health Policy at the Univ. of Cal., SF, and senior author of a recent study analyzing grotesquely excessive administrative costs of insurance companies and how it diverts several hundred billions of dollars annually from actual hands-on medical treatment.

What appears as wasteful to the normal person such as the enormous resources devoted to complicated billing and other insurance related activities (BIR), as documented by Dr.Kahn, is considered as income and revenue by insurance companies because they charge for these excesses.

Thus, extravagant squandering of funds and resources is endemic to the business model of insurance companies and precisely because it adds to their bottom line, there is no incentive to eliminate the bureaucratic discombobulation.

Healthcare economics scholar Uwe Reinhardt expressed his exasperation even before ACA in his Nov. 19, 2008 testimony to U.S. Senate Finance Committee: “900 billing clerks at Duke with 900 beds. Not sure we have a nurse for each hospital bed but we have a billing clerk. It’s obscene.”

This chronic problem has grown with ACA.

Dr. Kahn tells me that his study measured billing and other insurance-related over-costs at an astounding $375B annually. A national health system that would offer the same comprehensive care for everyone without fracturing care into thousands of different plans “would save us billions,” he says.

He points to Australia and Canada, where government medical insurance administrative fees are lower than 3%, similar to our Medicare.

Kahn also indicated in our interview that these lower costs are sharply contrasted to the 33% administrative toll for care funded through U.S. for-profit insurers – all of which we pay.

These figures are truly stark.

“It makes no sense,” Kahn said, “to unnecessarily spend what amounts to $1200 extra each year for every man, woman and child in the U.S. just to push papers around” as part of the billing and extraneous marketing functions of insurance companies.

We have to return to a “focus on quality clinical care where the patient and health provider themselves consult directly about the best care available,” Kahn emphasized, without jumping through hoops of complex and cumbersome financial restraints encoded in each policy.

Activists like Bechler hope that experience with ACA will awaken more to support HR 676 National Health Care Act which provides Medicare for All or Single Payer as supported by Dr. Kahn and Dr. Geyman.

Realistically, however, he says that the daunting economic and political power of insurance companies means we have a lot of grass roots organizing to do.

We must first recognize fatal flaws in the ACA and then act to get something better, Bechler suggests, by signing up for activities at http://www.singlepayernow.net/ in California or nationally at https://www.healthcare-now.org

Carl Finamore is Machinist Lodge 1781 delegate to the San Francisco Labor Council, AFL-CIO. He wishes Medicare would be expanded and extended to include everyone. In the meantime, he hopes his good genes get him through. He can be reached at local1781@yahoo.com

More articles by:

Carl Finamore is Machinist Lodge 1781 delegate, San Francisco Labor Council, AFL-CIO. He can be reached at local1781@yahoo.com

bernie-the-sandernistas-cover-344x550

Weekend Edition
June 14, 2019
Friday - Sunday
Michael Hudson
Trump’s Trade Threats are Really Cold War 2.0
Bruce E. Levine
Tom Paine, Christianity, and Modern Psychiatry
Jason Hirthler
Mainstream 101: Supporting Imperialism, Suppressing Socialism
T.J. Coles
How Much Do Humans Pollute? A Breakdown of Industrial, Vehicular and Household C02 Emissions
Andrew Levine
Whither The Trump Paradox?
Jeffrey St. Clair
Roaming Charges: In the Land of 10,000 Talkers, All With Broken Tongues
Pete Dolack
Look to U.S. Executive Suites, Not Beijing, For Why Production is Moved
Paul Street
It Can’t Happen Here: From Buzz Windrip and Doremus Jessup to Donald Trump and MSNBC
Rob Urie
Capitalism Versus Democracy
Richard Moser
The Climate Counter-Offensive: Secrecy, Deception and Disarming the Green New Deal
Naman Habtom-Desta
Up in the Air: the Fallacy of Aerial Campaigns
Ramzy Baroud
Kushner as a Colonial Administrator: Let’s Talk About the ‘Israeli Model’
Mark Hand
Residents of Toxic W.Va. Town Keep Hope Alive
John Kendall Hawkins
Alias Anything You Please: a Lifetime of Dylan
Linn Washington Jr.
Bigots in Blue: Philadelphia Police Department is a Home For Hate
David Macaray
UAW Faces Its Moment of Truth
Brian Cloughley
Trump’s Washington Detests the Belt and Road Initiative
Horace G. Campbell
Edward Seaga and the Institutionalization of Thuggery, Violence and Dehumanization in Jamaica
Graham Peebles
Zero Waste: The Global Plastics Crisis
Michael Schwalbe
Oppose Inequality, Not Cops
Ron Jacobs
Scott Noble’s History of Resistance
Olivia Alperstein
The Climate Crisis is Also a Health Emergency
David Rosen
Time to Break Up the 21st Century Tech Trusts
George Wuerthner
The Highest Use of Public Forests: Carbon Storage
Ralph Nader
It is Time to Rediscover Print Newspapers
Nick Licata
How SDS Imploded: an Inside Account
Rachel Smolker – Anne Peterman
The GE American Chestnut: Restoration of a Beloved Species or Trojan Horse for Tree Biotechnology?
Sam Pizzigati
Can Society Survive Without Empathy?
Manuel E. Yepe
China and Russia in Strategic Alliance
Patrick Walker
Green New Deal “Climate Kids” Should Hijack the Impeachment Conversation
Colin Todhunter
Encouraging Illegal Planting of Bt Brinjal in India
Robert Koehler
The Armed Bureaucracy
David Swanson
Anyone Who’d Rather Not be Shot Should Read this Book
Jonathan Power
To St. Petersburg With Love
Marc Levy
How to Tell a Joke in Combat
Thomas Knapp
Pork is Not the Problem
Manuel García, Jr.
Global Warming and Solar Minimum: a Response to Renee Parsons
Jill Richardson
Straight People Don’t Need a Parade
B. R. Gowani
The Indian Subcontinent’s Third Partition
Adolf Alzuphar
Diary: The Black Body in LA
Jonah Raskin
‘69 and All That Weird Shit
Michael Doliner
My Surprise Party
Stephen Cooper
The Fullness of Half Pint
Charles R. Larson
Review: Chris Arnade’s “Dignity: Seeking Respect in Back Row America”
David Yearsley
Sword and Sheath Songs
FacebookTwitterRedditEmail