The Craig Fahle Show

Craig Fahle: Essay on Health Care

June 28th, 2012





Progress. What leads to progress?

Oscar Wilde once said that “discontent is the first step in the progress of a man or a nation.”
Now far be it from me to try and improve upon Oscar Wilde, but I want to add something to that. Discontent is a part of EVERY step in that progress. I get what Oscar meant, and he’s right. Without outrage…without someone feeling wronged, where’s the impetus for change? Where’s the motivation to fix something? Minus the spark…combustion doesn’t happen. I think its worth remembering what the spark was that started us down the road to the Affordable Care Act. Especially now, when in just a few moments, we’ll learn just how much of that law, if any, will remain on the books.

Its worth remembering the health care system that existed just a few months ago. A system where insurance premium hikes of more than 10 percent was common. A system where companies could deny coverage based on a pre-existing condition. A system where coverage could be cancelled by the insurer, simply because a person got sick. A system that rewarded insurance companies for cherry-picking healthy customers that are far less likely to file a claim. Young and healthy? No problem, here’s a policy for you. 55 years old with high cholesterol? Sorry…you better hope you hang on for another ten years until you are eligible for Medicare. If you get sick before that? Well, go to the emergency room for treatment. Hopefully, you can pay that. But what if you can’t?

Hospitals have a mission to treat the sick, regardless of the ability to pay. In 2008, The New England Journal of Medicine found that hospitals provided 43 BILLION dollars in unreimbursed emergency care. Urban hospitals like the DMC nearly collapsed under the weight. This led hospitals to raise fees on other services to make up for the bills that will never be paid by the uninsured. Uncompensated care also started a drive for something called a better “payer mix,” leading hospitals to locate more facilities and better services in wealthier neighborhoods where there are more insured customers…often at the expense of older facilities in poorer neighborhoods, lessening even further access to services for the uninsured. How do the insurance companies handle the rate increases coming from hospitals and doctors? Simple - just jack up everyone else’s premiums to cover the increase.

How much more is your share of your employer plan than it used to be? And for those of you without employer sponsored care, how are your premiums compared to a decade ago, if you can even afford a plan? Many can’t. Sure, some choose not to carry insurance. But the majority of the 46 million people currently NOT covered by any insurance simply can’t afford it. A lack of insurance can be financially catastrophic. This is a health care system, according to a study by Harvard Law and Ohio University, that was responsible for 62 percent of all personal bankruptcies in 2007. Of that 62 percent…75 percent HAD health insurance, and still went bankrupt due to medical bills.

This makes no sense. At least, it makes no sense if public health is your primary concern. And there’s the spark. There’s the discontent. That’s Wilde’s first step towards progress: the feeling that the health care system isn’t about health care, as much as it is about insurance companies and money.

But wait, you say…America has the best health care system in the world! We may have the best doctors…the best facilities, the best technology… but only if you can access it. If you’ve got insurance, the system is quite good. If you don’t…well that isn’t much of a health care system at all, is it?

The affordable care act, for all of the criticism it gets from the right, and also the left…is at least an attempt to change a broken system, an attempt to regulate much of the malodorous behavior of health insurers. But it was also an attempt to keep insurers in the game. Gone is the idea of Medicare for all, a public option, or truly universal coverage. Socialized medicine? Hardly. In fact, the ACA was actually an attempt to further entrench the private sector in the health care system. In exchange for the changes in policy, the health insurers were given a guarantee that those that don’t buy insurance, especially those coveted young and healthy individuals, would have to buy a policy. That’s the individual mandate. This firms up the actuarial tables, and begins to make insuring everyone a much more palatable idea to the insurance industry. Without the mandate…only the new regulations stay in place. This isn’t fair either. It creates a system that can only lead to bigger premium increases to cover the costs of requiring coverage for anyone who asks for it.

Some argue that this possible scenario means the court would have to strike down not just the individual mandate, but the entire act.
That may happen. And if it does…we’ve got a lot of work to do, because I’m not sure the public is willing to go back to the system that was. New polling data released just this week by Reuters-Ipsos shows that big majorities of REPUBLICAN voters actually like most of the ideas in the Affordable Care Act.

That’s a problem for those advocating repeal of the act. The public actually likes the new regulations on insurance companies…and likely won’t accept a return to the status quo of a broken health insurance system.

So I conclude with this…for those politicians that have been so outspoken against this attempt at a fix…what’s your idea? It is time to put up or shut up. It’s easy to be against something…but its long past time to tell us what you are actually FOR. I’d hate to think you haven’t figured that out yet. For if you haven’t, there’s an even bigger spark to fuel an Oscar Wilde –fire.


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