Once again the Republicans have failed to destroy the Affordable Care Act (ACA or Obamacare). I’ve lost count of the number of attempts and I’m beginning to wonder if their goal isn’t just to keep everyone distracted enough to keep Congress from doing its job, i.e. fixing the problems with the system we have. I still believe it’s time for the United States to join the rest of the developed nations and offer our citizens a national health system. But in the meantime the ACA is a good beginning, despite its problems.
After more than 40 years as a registered nurse working in numerous areas of healthcare, including working for several insurance companies as a healthcare risk manager, quality assurance specialist and appeals nurse specialist, I believe I can provide some insight into the problems and solutions.
The standard response has been to blame the greedy insurance companies, or the currently sick (those with pre-existing conditions), or the poor.
Let’s first address the sick; the attitude appears to be it must be their own fault they’re sick and so why should the rest of us have to pay for their care? Yes, some of the sick have conditions they might not have developed if they had lived cleaner, purer lives. But can any of us actually claim to have lived clean, pure lives or that we’ll never get sick, or old? No, you pay for insurance now, to cover those who need it now, so when it becomes your turn to need it, you’ll have it.
Also of note: As a counterproductive measure there’s a strong movement to remove all preventive coverage from the current plans as a cost saving measure now, thereby insuring more sick people, with more costly illness in the future, and around and around we go. So to sum up, no one can guarantee they’ll never acquire a chronic illness, or have an accident resulting in costly and/or extensive care.
And now the poor. Again, the general attitude seems to be if they’re poor it must be their own fault, so why should we take care of them? In the past we tried not taking care of them. Having people dying just outside the doors of hospitals got enough good people so upset Congress passed a law against refusing them care. So be assured, we pay for care for the poor one way or another. It’s just much cheaper and much better for society to get them covered under insurance and give them preventative care then it is to have them get really sick and spend months in the hospital.
Onto the young people. There has been a lot of talk about how young people shouldn’t be penalized for not having health insurance and they should be allowed to buy cheaper, more limited plans. Again, we pay for insurance now for those in current need so it will be available for us later when we need it, because we’re all going to need it at some point in time. And what a scam, offering the young cheap plans with limited coverage, then when they get sick, or injured, and need the care, it runs out quickly and then they have a pre-existing condition and aren’t eligible or have to pay outrageous premiums to get insurance. Sounds to me like a bait and switch.
So what is the answer, why are health care costs so high? Is it greedy insurance companies? They do have profit margins in the double digits. But how about the pharmaceutical companies, Durable Medical Equipment(anything from a cane to a fancy MRI machine) companies, their profit margins are in the triple digits? And even hospitals (especially not-for- profit hospitals) their profit margins are third in line after the pharmaceutical companies and DME companies. The insurance companies actually run a distant fourth after the big three.
Talk about a vicious cycle, these companies earn lots of money, so they can afford high priced lobbyists, who can convince our representatives to pass laws to further protect them, so they can make lots more money. Guess who’s been getting the short end of the stick?
Want to know why your premiums keep going up and up and up? The tendency is to blame the insurance companies, but think about it. Pharmaceutical companies not only charge outrageous amounts for their medications, they also run ads to convince us we need more medications and we should ask only for their brand name drug, You can listen to an old This American Life segment from Oct. 16, 2009 at https://www.thisamericanlife.org/radio-archives/episode/392/transcript. You’ll not only learn about how drug companies trick patients into insisting on unnecessarily expensive drugs, but also several other insightful tidbits still relevant to the problem. DME companies advertise their expensive equipment in an effort to convince patients they should demand the fanciest, latest tests and the newest interventions (such as robotic surgery) regardless of real need. And hospitals feel like they have to buy the fanciest, latest gadgets, and the showiest, facilities. The insurance companies have to pay for all that and, of course, they’re going to pass that on to the customer, you. Just like any other good business would do.
So what can we, the consumer, do? Well No. 1, turn off the sound bites. This is a complicated issue and you will never get the information you need to make informed decisions based on a 30-second sound bite. Too much trouble or too confusing to do? Well, it’s your dollar, your health, your life, what is that worth to you? Look for information from non-partisan sources. A good place to start is with such sources as Steven Brill’s Time Magazine article, “The Bitter Pill,” from March 4, 2013. You can find it online at http://content.time.com/time/subscriber/article/0,33009,2136864,00.html. And his book, America’s Bitter Pill: Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System, you can get this through the Carson City Library. Also look for the documentary Escape Fire: The Fight to Rescue American Healthcare, which can be found on YouTube, Amazon Video, and other sites.
No. 2, by living that cleaner healthier life, simple changes like a 30-minute daily walk, eating more fresh fruit and vegetables, getting at least seven hours sleep a night can have a profound effect on your health.
And No. 3, write, call, email your representatives and ask them if they’re willing to sponsor and/or vote for bills that will remove the protections for the pharmaceuticals and DME companies, remove nonprofit status from hospitals earning large profit margins, and to pass a law limiting all segments of the industry to a reasonable profit margin! Let them know you want to keep your health insurance and your preventative health care. You just want healthcare to cost everyone less. And if they don’t do it, vote them out of office and vote in someone who will. And keep doing so until we have enough representatives in Congress to truly represent us.
And just to get ahead of what I know some will say, it would be illegal for Congress to set limits on business’ profit margin, they actually do it all the time. And besides, this is truly a national emergency and it should be treated as such.
Carson City resident Donna Inversin is a retired registered nurse.
