We Are Looking at Health Insurance All Wrong
The current debate about healthcare, ACA (aka Obamacare) vs. AHCA (aka Trumpcare) is centered around one flawed premise: we have to have health insurance in a market based system. Starting with that premise, every debate is then centered around how to best keep the American people from being too gouged and hurt from health insurance companies:
“We have to do something about premiums!”
“Deductibles are too high!”
“Companies are pulling out of markets in these states!”
We treat healthcare as a commodity, just like buying a car. Healthcare is one of the single biggest purchases Americans make, yet unlike these other purchases, it’s not optional. But yet, we keep laboring under the assumption that we have to have insurance companies, and that we have to pay whatever they choose to charge us, with no real alternatives.
The solutions proposed thus far have all focused around still keeping insurance companies happy, while trying to stave off the devastation to consumers: premium subsidies, health savings accounts (HSAs), expansion of Medicaid, etc. Meanwhile, these insurance companies keep raking in record profits. Our taxpayer funded subsidies under the ACA saved most exchange customers money, but the premium help, funded by tax payers, still went to the insurance companies, who still have the audacity to complain.
Every way you slice it, this system has been designed to only continue to bolster the health insurance industry. And what have they given us in return? Higher and higher premiums, deductibles, co-insurance and co-payments. The ACA put rules in place to keep health insurance companies honest and humane: you can’t discriminate against anyone with pre-existing conditions, you can’t charge older people more than 3 times what you charge younger people, you can’t kick people off when they get sick or impose a spending cap, you have to cover preventative health care, like well baby visits and mammograms fully, no matter how much of the deductible was spent. The health insurance companies, whose only mission is to continue to pay out money to their share holders, responded to those rules by continuing to increase their premiums, and stage a coup by pulling out of market states to say “see, the ACA is so terrible, we have to leave.” No, they didn’t. They chose to. They were never in danger of insolvency, they just weren’t making enough money of those people in the exchanges.
So, unless you meet the income requirements for Medicaid, the age or disability requirements for Medicare, or are a veteran and qualify for Tri-Care, what are you to do?
When faced with any other major purchase, you have options. First of which is to not buy it. If I want a car, and I can’t afford it, I don’t have to buy one. I can find alternative transportation, I can structure my life so I can walk or ride a bike (if able), I can hound my friends for rides, etc. The second option would be to use a public form of transportation. It might not be as convenient as a car, and may not cover everywhere I need to go, but it can get me places I couldn’t go with walking or riding a bike. Now, if I wanted the convenience of a personal car for my transportation, I saved up, and was able to buy one, along with all the insurance and maintenance that surrounds a car, then I could choose to pay all that extra for a car. And if after all that I still don’t have a car, my life will not be in danger.
The same is not true for healthcare. You have no real alternative. Paying cash for healthcare services is not wise or really possible. We have been forced to participate in a market that has us held hostage, literally as a matter of life or death. We are being forced to pay up, or suffer and die.
If that’s not extortion, I don’t know what is.
Everyone needs healthcare, and the more preventative care you get up front, right now, when you’re young and healthy, the better outcomes you’ll have, and the cheaper your healthcare costs will be. Healthcare can’t be looked at as some luxury item that you should save up for, or as something that can be offset a year from now in a tax break.
Everyone needs access to healthcare NOW. Everyone needs access to quality medical care, medication, treatments and therapies. Not next year, not after we get our tax returns back, now.
So what can we do about being held hostage by this system?
We fight back.
We challenge the premise that health insurance companies are the only ones who have a right to provide healthcare to Americans. We fight back with our dollars, and make an investment in ourselves and each other.
I am proposing that we, as Americans, as Michiganders, be allowed to form a Public Health Union. We should not be held hostage to buying insurance from insurance companies. I am proposing the start of a Public Health Union, where individuals and families can pay reasonable premiums each month, and receive all ten essential health benefits outlined in the ACA:
- Ambulatory patient services (Outpatient care, going to your doctor’s office)
- Emergency services.
- Maternity and newborn care.
- Mental health and substance use disorder services, including behavioral health treatment.
- Prescription drugs.
- Rehabilitative and habilitative services and devices.
- Laboratory services.
Without deductibles, without copays, without co-insurance. When the motive behind premium payments is covering costs of healthcare services without making a profit, modest premiums can more than cover the cost of health insurance.
I am proposing a Public Health Union that lets the people take care of each other, when health insurance companies won’t. I’m proposing this be an optional health care solution, because not everyone will want to participate, and we should all be free to choose. This is America after all, and we should all have freedom of choice.
As a nurse, as a mother, as a consumer, I am tired of being forced to participate in a health insurance system that sees human beings as walking (or rolling) dollar signs, and this is what I propose to do to change it.