Life isn't a crap game

I was gonna let this go, but....

        Saw a thread on FB with someone asserting, yet again, that killing the Affordable care Act (ACA)  won't hurt anyone with or without any alternative in place. The poor benighted soul who wrote the most emphatic defenses of the Trump proposal did so by citing a "1946(sic) law" requiring ERs to treat any person who presents. It was 1986, not 1946, but the error is minor compared to the rest of the screed.

        So where did he go wrong? To begin with, killing the ACA will immediately allow insurers to "dump" persons whose pre-existing conditions are costing them (the insurer) more than the policy's premium. At any rate, even if the insurer has some conscience, not a good bet, I fear, the rate can be raised by such an amount as to force the insured to voluntarily drop the policy. At that point the insurers will simply pull a Pontius Pilate, absolving themselves of either responsibility or accountability.

        So, some who are now covered will certainly lose coverage.  Additionally, it must be pointed out, although it's obvious to any thinking person, that preventive care at an office is far cheaper than ER treatment when the condition is critical. This is far too often the case with uninsured people. Three or four pre-natal visits, covered by insurance, are far less costly than even a two extra day hospital stay due to complications which were avoidable, but not addressed until an emergency delivery. Lest one think this is just one man's opinion, my wife, the  neonatal critical care nurse, has seen it far too often, rarely with good outcome for mother or child.

        Even more bizarre, is the apparent belief that it's OK to kill the ACA because " 'those people' will still have Medicaid." This misguided fiction  has monumental  flaws. First, Medicaid has some limits as to what care and/or how much might be spent on a given patient. The even bigger flaw is that those morons who don't think the government should help subsidize private insurance apparently don't understand that the same pot of money (the federal budget) pays for Medicare anyway. So if the money issue is a wash, what is the objection? Oh, yeah, the ACA was signed into law by the Black guy.    

        The real issue for the Paul Ryans, John Stossels and their ilk (I'd include Trump, but he's incapable of thinking this through, ergo just tweets his support as he's told), is that even though  The ACA is basically a gift to private insurance in the sense that it actually requires more Americans to use it,  It also costs the Government money  in a "right now/today" visible manner vice simply adding the same bucks to  Medicaid costs. The most rabid opponents of the ACA, led by Paul Ryan also would love to dismantle Medicare, and he has said as much, specifically. This constitutes a shameful willingness to sacrifice the access of tens of millions of Americans to decent health care on the altar of "free market" capitalism.

       Moving on; one might think with all the flak in the air re: the ACA that many, even a majority, of Americans like the National Health Care system (to use a grossly inadequate term) as it is and resent the changes posed by the ACA.

        Let's first examine the term "National Health Care System."  For those not on Medicare or Medicaid, the term is practically devoid of meaning, as they have no interface with the government other than a small Medicare contribution from their pay.

       Sadly, for those on Medicare or Medicaid, the situation is little better. Even though Medicare does cover some of a senior's health care cost, (which is generally inadequate as most must buy add-on supplemental plans or go broke) , it does not make appointments, insure quality of care, insure a national licensure quality control, and most tragically, it is forbidden to negotiate drug prices. What, you ask do I mean? I mean that Medicare, (note, not Medicaid) pays full price for any and all drugs, per the 2006 Medicare part D law, and cannot legally do otherwise.

        What does this mean? It means that a huge portion of the admittedly already huge Medicare budget goes to pay full retail for drugs for which no other entity pays full cost! While high drug costs are the lion's share of  the increase each year in overall healthcare costs, the case of Medicare is a national scandal. In order to get Part D (the Medicare drug plan) passed in 2006, the Bush administration  caved to overwhelming lobbying pressure from Big Pharma and  added to the Part D language the promise that Medicare would always pay full price for prescription drugs. The VA, which has no such restriction pays $170 or so for the EpiPen 2 pack. The same exact prescription for a Medicare patient is billed, and the manufacturer paid,  at the ludicrous $600+  level! Privately insured persons can use the manufacturer's generously supplied coupons to reduce  cost. The exact same prescription from the same doctor will be billed to Medicare at full price. The coupon may not be used if the recipient is a Medicare patient. Even Medicaid pays 23% less than Medicare.

        Still wanna kill the ACA? I believe your concerns should be directed elsewhere, at the drug industry, for a start. An industry with an industry wide  (roughly) 20% net profit margin (many individual Pharma firms are far higher, over 30%!) hardly needs to be allowed to soak the government and the Medicare patient when all private insurers negotiate substantially lower costs across the board.  

        Another ludicrous statement which appeared in  this thread was that observation that "If Norway can provide health care for all citizens why cannot the US do the same?" The simple answer is that Norway spends 4.9%  of GDP on defense, while the US spends 54% . Ya think that has an effect on the availability of money for health care? Having said that, Norway also spends a (slightly) lower percentage of GDP on healthcare, yet many Americans bristle at the mere mention of national single payer health care system. If this is the case, one might suppose that it's because most Americans are happy with the quality of their health care and resist any change.

        The unfortunate truth in the matter is that while the USA leads developed nations in per capita spending on health care, it is dead last in every single (yes every one) survey of overall user satisfaction regarding health care. The other end of the spectrum - "most satisfied"? the UK, with its national health care system. This has been the case for years, and is so even in an early 2017 survey. The figures are self explanatory.  The table below shows that in a recent compilation of surveys of more than 20,000 respondents, the UK has the highest health care consumer satisfaction rating and the USA the smallest.

Note specifically that in "timeliness of care," While the US ranks 5th, the UK is higher at 3rd. What is amazing is that the UK accomplishes this superior service at a much lower cost per patient than the USA. In fact, the UK spends less than half as much per patient to provide better service and make consumers happy. Now stay with me here. If the government spends under half as much as we currently pay per person to provide better care, isn't that a savings to the nation?

        How in the world can the UK accomplish it? To begin with, they believe that providing good universal health care is too important to be profit driven. Paul Ryan, John Stossel and Donald Trump do not.  Of course all the aforementioned can easily afford top tier health insurance, so why should they care?

       In Ryan's case, he should care because he was elected to (allegedly) "do the right thing for America," but this man, who received Social Security benefits after his father's death seems to have come to the conclusion that said benefits are/were evil. It's enough to make your head hurt.

        In Stossel's case, he's made his journalistic creds, such as they are, as the unabashed apostle of Free Market capitalism. As a credentialed historian, I would point out that there have been 9 major "panics" , recessions and depressions in the USA since 1815. The root causes of every single one of these can be directly attributed to the unregulated greed which Stossel has rebranded as Free Market capitalism. The speculators, would be monopolists and their ilk who caused the events which sparked these catastrophic economic crashes largely survived, a little poorer, perhaps, but never hungry. Banks crashed, but bankers survived;  depositors, not so much. Trusting private interests to do the right thing has resulted in a long history America of  innocent persons being hurt in various ways. 

       Some things are so important that, for better or worse, they merit government  regulation in the public good. Health care is very near the top of that list. Nestled close to it is supervision and regulation of financial markets. This isn't "Socialism." Medicare as it currently exists is socialism - same benefit regardless of contribution. Period. This is consumer protection and fiscal common sense. The profit driven crap game between Big Pharma and insurance profit with,  US health care and  quality of life as the ante, needs to end.