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Obamacare: Fail!

Updated on January 18, 2016

■ Despite the media's incessant yapping about United States "exceptionalism," The Commonwealth Fund found that when rated against 10 of the world's other developed countries' healthcare systems, the "exceptional" United States ranked highest in expense yet 11th in performance.

Our healthcare system before the Affordable Care Act or ACA (otherwise unaffectionately known as Obamacare) was a corrupt, money driven, gigantic mess. There's no point in going into all the perfectly valid reasons our pre-Obamacare healthcare system required a complete overhaul. It's been done - ad nauseam. Statistics for the United States were either astronomical or embarrassing (depending upon which ones you were viewing) compared to healthcare systems in other first world countries. Yet, despite the numbers, a great many people still argued for the status quo. My assumption is that these people had never been through a major medical procedure - which is where the real problems with the prior system became readily apparent.

January of 2013, pre-Obamacare, I was dealt the pleasure of going through my first major surgery. What I thought was a kidney stone, annoying but not a big deal, wasn't and today I am missing a semi-big chunk of my insides, actually a fairly routine procedure for a lot of women. My previous fairly minor forays into the dreaded maws of a hospital had already made me a single-payer system advocate, but this recent excursion into the world of medicine simply sent me back into a tizzy of fury.

Because while some claim Obamacare is a step in the right direction for our healthcare system, my suspicions from the beginning have been confirmed - Obamacare will do absolutely nothing to fix the inherent lunacy of the previous one. Our much trumpeted new healthcare system is still a corrupt, money driven, gigantic mess. Leave it to our colossally incompetent government officials to replace an existing gigantic mess with a brand new gigantic boondoggle - instead of a single-payer system or, as some refer to it, "Medicare For All."

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Obamacare has NOT reduced the paperwork!

■ According to BMC Health Services Research, $375+ billion is wasted on billing and health insurance-related paperwork annually - more than $1 trillion over a three year period!

• Pre-ACA: I filled out pages of forms to get my insurance. My policy manual arrived and it was close to a 1/4-inch thick. I filled out pages of forms before I could see any doctor for a first appointment. And then, after this particular surgery, I received stacks of bills.

At one point, I wasn’t sure when the bills would stop arriving. I didn’t even recognize the names of all the doctors or companies sending me the statements. The sheer amount of paperwork being shuffled by all the various companies was ludicrous! Never mind the enormous waste of paper, this is just not how a competent system works – no MBA required!

And not only was there a mountain of paper, but I had to sort out at least three (that I found!) discrepancies in the billing - which in total took hours on the phone to resolve. Call your insurance company, be told you have to call your doctor, call your doctor, be told you have to call your insurance company . . .

• ACA: Obamacare will do nothing to rectify this! In fact, Obamacare has only increased the bureaucracy of an already bureaucratic nightmare.

• Single Payer: reroutes the enormous amount of money currently wasted on administrative costs into actual health care.

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Obamacare has NOT brought transparency to the system!

■ Want to find out what you'll owe before you owe it? As the so called experts advise? Not always so easy!

• Pre-ACA: Did I understand exactly what I was paying for? Well, yes, in a general sense I did. I had had an operation. But how was I to know someone didn’t screw up and charge double for my anesthesia?

In an attempt to make sure this wasn’t happening, I asked the hospital for a printout of their charges (another, albeit smaller, stack of paper) which they happily gave me. Their personnel have been well trained not to balk at such requests because they know full well that you won't understand a single word of what they hand you anyway – hence no bickering over the bill.

It was obvious that I was expected to pay the hospital bill on the blind faith that I actually did have done what they said I did. That’s a lot of faith I don’t have! When else are you expected to pay for something without really knowing what you’re paying for? That there are companies whose very existence is to determine whether or not you were charged incorrectly on your medical bills should speak volumes as to the state of our healthcare system. Yes, silly, of course there’s a fee for this!

• ACA: Obamacare will do nothing to fix this!

• Single Payer: transfers the responsibility of controlling costs and errors from the patient to professionals who understand the field and do not profit from the outcome!

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Obamacare has NOT removed the hidden costs of today's health insurance: premiums, co-pays, deductibles and coinsurances!

■ A report published by the American Journal of Medicine in 2012 (based on statistics from 2001 to 2007) stated that:

  • over 60% of the bankruptcies in America during that time were due to overwhelming medical costs.
  • 75% of those who filed for bankruptcy had health insurance.
  • bankruptcies due to medical costs rose by 50% during this six year period.

While the numbers were taken years before the Obamacare rollout, the new system is inherently the same as the old and costs have only continued to spiral upwards. One of the report's authors summed up the terrifying reality every American but the 1% continues to face:

“Unless you’re a Warren Buffett or Bill Gates, you’re one illness away from financial ruin in this country." — lead author Steffie Woolhandler, M.D.

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Pre-Obamacare Visionaries

• Pre-ACA: It’s not as though I didn’t have health insurance when I had my surgery - I did. As much as I’ve always hated health insurance companies, the thought of being devastated by a massive, unexpected medical bill has scared me into being covered, one way or another. I had an individual policy and was feeling quite “covered” . . . up until this surgery. It wasn’t until after the surgery that I found out all the things it didn’t cover and how little of the things it did cover it really didn’t cover. Complicated? There’s an understatement.

Once the dust had settled, once I had paid my co-pays and deductible, I realized that I had probably paid almost 40% of the total medical bill. There's something inherently wrong with a system in which it is advisable to have not only a primary health insurance policy but also a secondary supplemental policy to cover what your main insurance doesn't. Welcome to the Twilight Zone. I would rather pay a set amount (fine, call it a "tax") monthly towards a single payer system, have my medical expenses covered when needed and not have to worry about being hit, out of the blue, by some huge, unexpected bill. Which, as some folks have found out, can lead to bankruptcy. Even with insurance!

• ACA: yep, same-old-same-old!

• Single Payer: removes almost all, if not all, out-of-pocket expenses.

A Sicko Lesson

Due to my impending medical bills at the time and therefore feeling especially sorry for myself, I decided to watch Michael Moore’s on-topic documentary, Sicko. I was sure that he would provide some truly despicable examples of our broken system and then maybe I’d feel a little better about my situation. I wasn’t wrong except that what were considered despicable examples in 2007 have become common place occurances - and even more horrific tales have surfaced since.

However, a conversation between Moore and Tony Benn, a former Member of the British Parliament, revealed some interesting thoughts on Britain's National Health Service I hadn’t previously encountered:

Moore: When did this whole idea that every British citizen should have a right to healthcare (begin)?

Benn: Well, if you go back, it all began with democracy. Before we had the vote, all the power was in the hands of rich people. If you had money, you could get healthcare, education, look after yourself when you were old. And what democracy did was to give the poor the vote. And it moved power from the marketplace to the polling station. From the wallet to the ballot.

And what people said was very simple. They said, “In the 1930s, we had mass unemployment. But we don't [sic] have unemployment during the war. If you can have full employment by killing Germans, why can't we have it by building hospitals, schools, recruiting nurses and teachers? If you can find money to kill people, you can find money to help people.”

Well, no wonder we’re having problems here in the United States! We’re no longer a democracy, all the power is in the hands of the rich and a quick glance at any pie chart depicting government spending makes it quite obvious that the Pentagon’s budget is one of the most important pieces!

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Obamacare has NOT controlled healthcare costs!

• Pre-ACA: The individual health insurance I have sends its insured an "Explanation of Benefits" statement showing the "Total Charged" for an appointment or procedure and then, in the next column, the “Repriced Amount." According to the Glossary Terms on the company's website, the "Repriced Amount" is the negotiated fee that a network provider has agreed to accept as the amount charged for the service.

Here’s an example from my surgery:

■ Experts advise us to "shop around" for medical care prior to appointments as they admit that prices for procedures can and do vary from hospital to hospital.

They're not kidding . . .

I recently required a UA test and did not follow the experts' advice and do my homework before getting it - past experience had proved that price checking was not always an easy task. Instead, I simply went to the local hospital in the very small town in which I live. Big mistake! The total bill came to $72.00 and my portion, after my insurance paid their's, was $39.96. I called the bigger hospital that did my surgery in a town farther away: $10.00. Before my insurance paid their part. I was livid!

A follow-up with the doctor required an ultrasound. This time I decided to call the local hospital for the price of the procedure before I got it: $500.00 if I used my insurance, $350.00 if I made payments and $280.00 if I paid the day of the appointment. Aren't those price variations fascinating? As I had been required to have an ultrasound before my surgery and seemed to remember the price being much lower at the hospital in the next town, I decided to call and verify their cost: $143.71.

My translation of this definition into English is that the Repriced Amount or "negotiated fee" is actually the true or close to the true cost of the service. My next impression is that the difference between these two totals is somehow supposed to make me appreciate how much I’m saving by having their insurance.

It doesn’t.

It makes me blind, crazy furious because while those numbers may be perfectly legal, they just look like a bad case of fraud.

To confirm my suspicions, I called my insurance company and asked them if the Total Charge, $3,264.00, was what could be considered the “retail” cost of the procedure and the Repriced Amount, $261.70, the “net” cost. The representative responded that, yes, that could be considered the case. So a person who does not have my insurance would be charged $3,264.00 but a person who does have my insurance would only pay $261.70 - for the same procedure.

How exactly do these people come up with these numbers?! What exactly is that markup?! Don't think for a minute anyone is losing any money here on the "Repriced Amount"!

■ a perfect example of why Obamacare is doomed: Is the Affordable Health Care Act Affordable? And why we need a single-payer system.

• ACA: and Obamacare will do absolutely nothing to fix this type of profiteering! So long as private corporations, driven by investors, are allowed to make a profit from people's health, costs will never be controlled.

• Single Payer: removes the concept of "for-profit" health care.

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Obamacare does NOT replace the accident that is employer-based health insurance!

• Pre-ACA: Yes, employer-based health insurance became what it is today by accident. An attempt by Congress to control civilian wages, but not fringe benefits, during World War II gave rise to this farcical concept. No group of health policy experts was consulted then and no such experts would uphold this utterly ridiculous proposition today.

Health, while always changing, is a constant in everyone's life whereas jobs come and go. Tying one’s health insurance, and therefore one’s health, to a job is an utterly illogical, Alice in Wonderland concept. What, pray tell, should your job have to do with your health (other than the obvious should you work in a coal mine)? This irrational link between employer and employees' health care has forced people to put their health on the line by attaching it to a relationship that is tenuous at best. For instance:

  • if your employer does offer health insurance, there's not much freedom of choice, you get what you get . . . if you're lucky, maybe with a couple of options. It may be good insurance or only so-so insurance (more likely the latter as health care costs continue to rise) - accept it, get your own or go without.
  • your employer may be a small company and not able to afford to offer health insurance benefits, leaving you to either go without or get an individual policy, if you can afford it.
  • some large companies actively try to avoid paying health benefits (Walmart, for example) by hiring only part-time employees - forcing them to either go without health insurance or get individual policies. These days, individual policies mean either a really big monthly outlay of money, a really big deductible, or both, which puts these usually poorly paid part-timers into the position of "do without."
  • leave or find yourself laid off from a job and you will quickly find out how ridiculously expensive COBRA is. At my last job with a small company, I had $60.00 taken out of each bi-monthly check (a pittance compared to what I pay now). I left the company and was told that COBRA would cost me approximately $550.00 per month! How many people can suddenly come up with an extra $550.00 per month?
  • find another job? Employers are allowed a maximum of 90 days before being required to offer an employee health insurance. Think COBRA or short term health insurance to cover this time. Or roll the dice.

• ACA: continuing the insanity.

• Single Payer: healthcare is independent of employment status.

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Time to actually fix the problem!

■ this chart by Physicians for a National Health Program (PNHP) shows additional ways in which a single-payer system stacks up against Obamacare.

None of these problems are going to improve with the ACA. Obamacare is a rewrite of the same old story with some minor tweaks. Health insurance companies are merging into less than a handful of monopolies gaining more power than they've ever had before - and the predictions are mostly grim:

  • fewer options for insurance
  • a decline in plan quality and customer service
  • cost increases for the uninsured
  • an increase in out-of-pocket payments
  • an increase in prescription costs

■ Still not convinced Obamacare is a "Fail"? 21 Ways Canada's Single-Payer System Beats Obamacare

It is hard to understand why every American is not vehemently opposed to a system that is so obviously broken for so many - and becoming worse, not better. Any country claiming to be "exceptional" should be able to do far better than the farce we tolerate as "healthcare" in America.

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Photo Credits:

[1] tekkaus, via photobucket | frame/text by Gemini Fox

[2] pruzi, via pixabay | frame/text by Gemini Fox

[3] trinitash83, via photobucket | frame/text by Gemini Fox

[4] aresauburn™ / Foter / CC-BY-SA-2.0 | frame/text by Gemini Fox

[5] konstas-samui, via photobucket | frame/text by Gemini Fox

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