Insurance is being referred to as a question of calculated risk and this definition is
being used to discredit concepts like comprehensive coverage and even the idea
of access.
And yet it must be remembered that the latter is actually the
key issue. For the working class and the poor, health insurance is not a
question of calculated risk. This is how the upper class and some of the middle
class approach the question.
For those at the bottom health 'insurance' has nothing to do
with a financial decision. This is purely about access.
Without insurance you are automatically cut out from a lot of
coverage. Many offices will not deal with you. Those that do, tend to treat you
poorly often demanding pre-payment for services. The whole doctor-patient
relationship is often affected. Some doctors put the ethical questions above
the financial and treat a patient without little regard to questions of
remuneration. Their numbers are few. Others
embrace an almost dismissive minimalism. Their attitude is 'pay-up or get out'.
Often the uninsured end up neglecting pending problems,
delaying basic treatments and end up in the Emergency Room where they're
granted a temporary type-of-access but little in the way of follow-up or
extended care. Debts mount because the costs are amplified when relying on the
ER for what often should be primary care.
The ACA has failed on several fronts but as many have pointed
out since it initially made its way through the Supreme Court, the failure to
mandate a Medicaid Expansion all but killed any possibility of success. The
Court's ruling opened the door to further attempts at universal coverage under
the auspices of a tax but at this point it may be a generation before it's
attempted again.
The elimination of the Medicaid mandate means that as of 2017
over twenty million people (perhaps closer to thirty) are still uninsured in
well over a dozen states.
This adds up to billions of dollars that are not flowing into the insurance industry. In the privatised
model which originated with the Heritage Foundation the only way it could work
is if the mandate for coverage was truly universal.
The 'Obamacare' victory celebrated in 2012 was premature and
short-sighted. The failure to bring everyone on board as well as a failure on
the part of the government to rein in costs has led to an escalation in
premiums for both employers as well as those purchasing policies on the
marketplace.
The medical industry is also experiencing what some refer to
as the Wal-Mart effect, an episode of consolidation and monopolisation.
Insurance carriers are consolidating and controlling vast areas, forcing out
competition and leaving very few options for consumers. Smaller hospitals and
even individual and group offices are being quite literally gobbled up by large
regional conglomerates.
Lower payments mean that stand-alone doctors either have to
take less from a shrinking pool of patients or join up. I've seen a few just
give up and retire.
This privatisation is leading to... more choices for
consumers? Hardly, it's leading to oligarchical control. Instead of a state run
system we're ending up with a corporate controlled system which in the end is
pretty much just like the state, except operating on a for-profit basis.
And of course when it comes to health care a for-profit model
means the commoditisation of people's lives and rank usury... profiting from
the suffering of others and capitalising on their misfortune and grief.
And we're told this is the Christian model. This is the model
supported by the politicised and apostate American Evangelical Church. We
should be proud indeed.
What is the solution? There aren't solutions in this world
that will bring uniform justice nor solve all problems. But it would seem that
the wealthiest nation in the world could probably do better.
Instead of Sarah Palin's government death panels we will now
have the real thing... panels of accountants and technocrats that decide (based
on the math) whether you will have a right to access... and for many a denial of access is the equivalent of a
death sentence.
One large issue notably absent from the Health Care debate with regard to Medicaid is the question of nursing homes. NPR and The Intercept have mentioned it but I'm not presently aware of much focus on the part of the mainstream media when it comes to this issue.
ReplyDeleteI can think of several Middle Class families I know with elders in nursing homes. Zealous GOP supporters I think they would be quite shocked to find that huge cuts to Medicaid will harm their nursing home coverage. Medicare covers senior citizen healthcare but Medicaid covers the bulk of nursing home care.
What many don't realise is that Paul Ryan, the Koch's, CATO et al. want to eliminate not only the Great Society measures passed by Johnson but ultimately the New Deal legislation implemented by FDR.