Republican lawmakers know very little about how health insurance works, and positively nothing about how health care itself works. Yet this group is about to impose their ignorance on the entire country. We should all be very afraid.
Ever since the Senate’s proposed bill saw first light last Thursday, I’ve heard advocate after advocate trying to sell their idea as good for the country, good for health care costs and premiums, and good for the actual care that Americans receive. Health and Human Services Secretary Tom Price is the worst . I’m pretty sure he’s had private tutoring sessions with Kelly Anne Conway because he’s got one script, and he uses it to respond to every question, regardless of whether or not it’s even relevant.
His favorite line is that one about how with “failing Obamacare,” people have coverage but they can’t afford care. I swear I’ve seen his talking head talking that shit ten times if I’ve seen it once. And it’s laughable because the republican idea of health care makes this exact problem way worse.
If, and this is a big if, the AHCA or the Better Care Act or whatever they’re calling it today does by some miracle decrease premiums, it will be exactly at the expense of paying for actual health care. It’s not hard to connect the dots. Tom Price talks about Obamacare not providing actual care as though this is what Republicans are working to fix. It’s not… by a long shot. The republican plan strips away the health care that Obamacare guaranteed with its cuts in Medicaid and its waivers on essential benefits.
If Republicans get their way and your premiums go down, it will be because your plan is no longer required to cover prescription drugs, maternity and newborn care, mental health, emergency care, and a whole slew of other services. They’ll even bring back yearly and lifetime maximum coverage amounts, so if you get really sick, your plan can stop paying and literally pull the plug on you.
How is that healthcare? The short answer — it’s not.
I get the frustration with high deductible plans. I have one, though it’s employer sponsored, so it’s at least somewhat more generous than what’s offered on the exchanges. Our family has a $3000 deductible, and our policy doesn’t pay for anything until then. Except preventative well care. Our plan, as required by the ACA, pays for well patient and preventative care. That means I get yearly mammograms and pap smears. It means the kids get their checkups and their shots. These are available to us without a copay or a percentage. The deductible,when it comes to well care, is not a factor. Well care happens outside the deductible framework entirely.
Do Republicans get this? Does Tom Price understand that every woman with health insurance in the US can get a yearly gynecological exam without additional cost without concern for deductibles? I have to assume he knows, but if he does, then every time he says people can’t use their healthcare because deductibles are too high, he’s being disingenuous; he’s knowingly misleading the American public.
Think on that for a second, and then let’s shift gears to what is arguably the real problem. The one that Republicans are ignoring completely, and that for the most part, Democrats did too.
The Price of Care
If you’ve had a diagnostic procedure performed in a hospital lately, chances are you experienced major sticker shock, especially if you’ve got a high deductible plan like I do. I’m currently in the middle of a health care situation that’s not only costing me a whole lot more money than it has to, but will also brand me with a pre-existing condition for the rest of my life.
For a few days in early May, I felt like I had a cramp in my right calf, and it just wasn’t going away. Of course I googled it, and self diagnosed a DVT blot clot. When in two more days it still hadn’t gone away, I went to the walk in clinic where my PCP practices. The doctor at the walk-in was pretty sure it was DVT, but standard diagnostic protocol is ultrasound. She sent me to the local hospital where the procedure confirmed our mutual diagnosis. I’m taking Xarelto, and once my course is completed, I have to see a hematologist to find out if there’s an underlying condition. Most of the time, DVT can be attributed to a precipitating event like a long plane ride or a pregnancy. None of these applies to me, so the next step is (hopefully) ruling out blood disorders and cancer.
A few weeks later, the bill from the hospital came in the mail. I owed the hospital $1200 for an ultrasound.
Clearly there had to be a mistake. Like the good free market healthcare consumer Republicans want me to be, I had gone home from my test and googled how much it should cost, so when the bill came, I’d know what to expect. The number I’d found was roughly $400. I tried to assure myself that this huge amount clearly must be a mistake, but the pit in my stomach knew I wasn’t getting out of this. I knew I was getting screwed, and I was.
It turns out that had my diagnostic procedure been done at a doctor’s office, the price would have been about the $400 I’d read about. But because it was done at a hospital, I was on the hook for three times that much. Yep, apparently that’s the way it works. I didn’t know it, but now I do, and now you do too.
Tom Price and Rand Paul want us to be savvy consumers of health care. Their thinking is that if we make health care a free market and allow customers to make choices about their own care, then prices will come down. Their thinking is horse shit.
Here’s where it breaks down. I had no choice about where my ultrasound was performed. My doctor sent me where she sent me. She didn’t say, “Oh hey just so you know, if you go to Guthrie Clinic instead of Wilson Hospital, you’ll pay way less.” That choice exists right now, but I had no clue until after the fact, when the damage was already done.
I get that part of the whole idea of high deductible plans is that they put more consumer skin in the game, and that theoretically this would create some competition. But it’s a total farce. Consumers don’t have any real choice. I didn’t know how much my ultrasound would have cost at a different facility. I didn’t have the first clue that there even could be such a huge disparity. Not getting the test was not an option. The doctor told me I needed a test to determine whether or not I had a blood clot that could break off, travel to my lungs, and kill me rather quickly. I was in no state or position to haggle.
Yet the republican position is that I was supposed to haggle. The car accident victim in the ambulance is expected to make sure the driver takes him to the most affordable hospital, the patient living with MS is supposed to monitor her army of specialists, treatments, and medications, to make sure at every turn she knows what her cheapest option is.
I can’t believe I have to say this, but shopping for health care isn’t the same as picking up groceries or buying a car. With groceries, you can peruse the fliers each week to see which store is having a sale on what items. With a car, you can go to the dealer armed with detailed information on which features you want and what you should expect to pay for them.
With the majority of expensive health care purchases, the average American can’t do either of these. You need it when you need it, and because it may be time-critical and/or life-saving, it’s clearly no time to discuss pricing options. Not that your ambulance driver or my walk-in clinic doctor would be able to quote you prices anyway. They don’t even work at or for the facilities their sending you to. The system just isn’t set up that way, and nothing the Republicans are doing is designed to change that.
Come on, Republicans, just stop. The problem with Obamacare is not that it gives too much money to too many people. It’s that it does nothing to contain the already crazy, yet constantly rising, costs of medical procedures. I’m lucky. I’ll pay for my $1200 ultrasound with money we put into a health savings account through my spouse’s employer. We’re fortunate enough to have employee sponsored health insurance, and we’ve made ourselves informed enough to use what’s available to us to prepare for situations like this one. But once that $1200 is used to pay for a $400 ultrasound, it can’t be used again. If any of us gets sick or injured before we’ve been able to build our HSA back up again, we’re screwed just like everybody else.
As far as I can tell, there’s nothing in the republican plan to lower costs. Just a lot of stuff about less money for poor people and more money for the rich.
President Obama let us down when he chose not to fight for “the Public Option”. Remember the Public Option? It would have been government run plan, similar to Medicare, available on the exchanges as built-in competition for private insurers. It was pushed hard by Progressives as a way to ensure an affordable option and to keep private insurers a little bit honest. Lobbyists made short work of the Public Option, and President Obama ended up dropping it out of his opening bid, not even using it as a bargaining chip to get a better deal for consumers.
So here we are now with insurers either raising their rates by unheard of margins or dropping out of markets altogether. And I can’t believe I’m about to say this, but who can blame them? If I had already reached my deductible, my insurance company would be paying 80% of my $1200 ultrasound. So while I have no love or sympathy for health insurance companies, when it comes to the cost of procedures, they can find themselves on the losing end too.
Just today, Elizabeth Warren came out for a single payer health care system. She’s encouraging Democrats to embrace the idea as the next step toward real universal coverage. She doesn’t have a lot of company at the moment. Most of her democratic colleagues are just hoping to protect the ACA from repeal. But having a high profile democrat like Warren supporting the idea is big step forward. With single payer, costs would be negotiated with the force of the one entity paying for all the patients. And this would apply to pharmaceuticals as well.
Could it be? Could this terrifying republican foray into health care actually move us closer to finally achieving affordable health care? I for one am hoping Elizabeth Warren knows something I don’t know and is timing her move accordingly.
This article by Teresa O’Shea originally appeared on OrangeIsTheNewWhiteHouse.org Used with permission of the author. All rights reserved.