- by Baker Lee
in FOH at Large
Trying to have a conversation about “Obamacare” opens the door to a maelstrom of hyperbole, rumors, partisan fear mongering and polarizing finger pointing. Having a similar conversation regarding “The Affordable Care Act” elicits a kinder and gentler response to the conversation even though — to quote William Shakespeare — “That which we call a rose by any other name would smell as sweet.”
Now, before one gets up in arms, please be aware that I am not suggesting that our healthcare system is a sweet smelling rose, since — as we all know— there are some very thorny issues that accompany the attributed appeal. The implication here is that a name as a selling point resonates on many levels and can easily turn an intellectual dialog into an emotional free for all, resulting in great acrimony and the gnashing of teeth without ever finding a common ground or resolution.
The Real Issue — Money
Therefore, putting aside any preconceived leanings, it seems to me that the real conversation regarding health care is about money. Who pays for health care, how much is paid and what services are rendered for said payments?
Many of us who are employed in the audio/production business work on a freelance basis and are therefore without the safety net of a company health care benefit package. At the moment, the upside of the current health care law is that if one is under the age of 26 years of age they can receive the benefit of staying on their parent’s insurance, but age is transitory and the law only provides a temporary relief before one is expected to fend for themselves. If a person reaches the age of 26 and they are still freelance or self-employed, it is imperative for them to figure out a suitable insurance plan, given that the law states they are required to choose a health care package or face a penalty fee for their refusal.
Known as the Individual Mandate, this law has become the source of great contention among those who consider it anti-constitutional for the government to legally force an individual to purchase health care. The concern was taken to the Supreme Court, who in 2012 voted 5-4 in favor of the Individual Mandate on the ruling that the mandate would be deemed a tax, which Congress had the ability to collect.
Regardless of political or sociological standing, we are all in need of some form of health care, if not for us then for a loved one such as a spouse or a child. Millions of people in this country were without affordable health care, and in 2009 a study suggested that close to 60 percent of U.S. personal bankruptcies were due to medically related causes. Surprisingly, many of these bankruptcies were by people who actually had insurance, but were not receiving benefits due to gaps in their insurance or uncovered services. Some people became so sick that they lost their insurance coverage.
The out-of-pocket expense for those who had insurance was calculated to be about $18,000 and, for those without insurance about $26,000. To pay these incurred medical bills, these people were required to mortgage or sell their homes, and even if these fees are only a part of the financial picture for the people in question, adding $18,000 to $26,000 of medical bills to one’s debt can never be a good thing.
Again, if we remove the emotional and ethically charged questions regarding the federal government’s involvement in a health care system, what we are left with is merely a monetary issue. Our health care structure is a for-profit system, and when the majority of uninsured patients do not pay their hospital bills, this leaves the hospitals holding the bag. Some of these costs can be written off or defrayed by raising costs for the insured patients, but either way, this becomes a loss for both taxpayers and policy holders.
The Individual Mandate — believed to have been initially conceived in 1989 by the conservative Heritage Foundation — is not just a means to forcibly bring people into the health care system, but also a way to protect the insurance companies against their rising costs. What the mandate allows is bringing young, healthy people into the health care pool, thus offsetting the costs incurred by the insurance companies when providing insurance for people with pre-existing conditions, older persons or for extending a child’s insurance until age 26. The mandate also ensures that people will maintain full-time coverage and not just buy and cancel policies on a for-need basis. These types of policies create massive losses for the insurers and then translates to huge spikes in individual premiums.
Separate, but Unequal
Not all health care insurance is equal, and costs can vary from state to state. Some of this is due to certain states refusing to partake in the federal subsidies program for Medicaid expansion, but in other cases, it is the policy one chooses. A musician friend of mine complained that while he only paid $300 per month for his plan, he had a $6,000 deductible. What this means is that he would have to pay the first $6,000 of care he receives out of pocket before the insurance company starts chipping in. He could have chosen a higher monthly payment, which would have lowered his deductible, but he was relatively healthy and rarely went to the doctor. He was obviously discouraged by the situation, but on the other hand, if he had required any major surgery or extensive care he would have only been on the hook for the $6,000, and not ten — or twenty — times that amount.
The ACA coverage plans are labeled as bronze, silver, gold and platinum — commonly referred to as the “metal tiers.” These are cost-sharing plans that determine how much one pays out of pocket and how much the insurer will pay. Not surprisingly, the more one pays for their insurance, the less they are required to pay out of pocket. The way it breaks down is this: Bronze: beneficiary 40 percent, provider 60 percent; Silver: beneficiary 30 percent, provider 70 percent; Gold: beneficiary 20 percent, provider 80 percent; Platinum: beneficiary 10 percent, provider 90 percent. There is also another category called Catastrophic which is for those under 30 years old or with a hardship exemption. This plan offers a low monthly premium, but a $6,000+ deductible. For someone who requires medical care on a more regular basis, it might be wise to choose a plan with a higher premium and a lower deductible. Let’s remember that the insurance companies are in a calculated risk business, but like casinos, the calculations are on the side of making (and not losing) money.
One of the main arguments against the Affordable Care Act is that it is viewed as a redistribution of wealth; a sensitive subject to broach in a money-driven society where the ideals and politics of health care are often used as selling points and/or scare tactics for one idea or another. However, regardless of any spin applied to the wording, the bottom line is always the profit that can be made. The mandate and raised taxes to subsidize the health care system’s less-advantaged clientele are certainly not a welcome addition to anyone’s financial burden, but hospital debt and raised taxes to compensate for the like are also not warmly embraced by the public.
Nevertheless, as the ACA mandate is already considered a tax, it means that on top of the taxes we already pay we are still paying another tax for our health care. If that is indeed the case, then why not figure out a way to incorporate our taxes into a single-payer plan that would be more cost-effective and less confusing to consumers and providers alike? Quite possibly, health care should not be a profit-driven business that enriches insurance and hospital CEOs.
Considering that most people will require some sort of health care in their lifetime, then the question we should be asking is not, “How can we do away with it?” as much as “How can we find a way — by using the existing fees — to fund a more efficient and beneficial program?