I’ve already written a little about my own situation with regard to healthcare. I’m not particularly concerned, but let’s review the scenario:
I recently resigned from an employer to start a new business. Having a thorough personal understanding of the importance of health insurance (ranking it just underneath food and just ahead of rent/mortgage in terms of financial priorities), I planned to enroll in an individual plan. I also have a pre-existing condition, which makes any change to my insurance circumstances somewhat of a hurdle. So right now, I face:
- getting approved for the individual plan for which I applied, albeit delayed while underwriters (at the same provider!) re-review my medical and health history because of my pre-existing condition, which has never resulted in the need for access to healthcare
- or, getting denied for the individual plan for which I applied, forcing me to rely on COBRA, which not only is extremely expensive but also expires after 18 months
At the moment, my situation is not an emergency. It could become extremely expensive in the short term if I’m denied for the individual plan for which I applied, but I’m not too worried about being declared to be uninsurable, although that is a slight risk, as it is for all Americans. But is this health security?
And this brings me to my point. The primary reason we need health insurance reform in America right now is to ensure that Americans have adequate health security in a world with better diagnostics and rising healthcare costs. As life expectancy has increased, so has medical technology and information improved. We know more about chronic conditions now, and we have data that gives us a better grip on epidemiology. And there are epidemics. Everything from diabetes to cancer. And right now we operate in a world where, for most Americans, health insurance benefits are a function of employment and employers, and private insurers prefer working with groups rather than individuals, from among whom they’re quite satisfied cherry picking.
Here’s the thing about healthcare. Unless we achieve some type of actual health insurance reform, every single one of the 47 million uninsured Americans who is uninsured because they are uninsurable as designated by a private insurance company will continue to lack access to health insurance until they have spent down their assets–cash, house, investments–to poverty level, which allows them to qualify for Medicaid. They must then remain at a function of the federal poverty line– lest they become ineligible for Medicaid–until they qualify for Medicare at age 65. The alternative is to keep one’s assets and hope that one can just keep living long enough to survive visits to the emergency room when things get really terrible because that’s the only place that has a mandate, and the mandate is just to stabilize emergency conditions. And don’t forget: They’ll still bill you later.
So let’s be clear: Every American who gets an unexpected diagnosis just before changing jobs, or while covered under COBRA, lives with the extreme risk that they will lose access to insurance. Every American who actually has private insurance, maybe even likes their plan, might not realize that that plan likely carries a lifetime maximum in terms of what the policy covers. Maybe $1m. Maybe $5m. Or an annual maximum. Or a high enough deductible that, if an injury or illness preventing work occurs, might become punitive when extended across 30 years.
Our system of healthcare in America right now is the best in the world… for healthy Americans! For unhealthy Americans, it becomes a nearly guaranteed system of oppression. This is why some form of universal healthcare is a necessity. Because anything short of that is a systematic short circuit of the American dream for anyone who winds up injured or ill. This is why we’re all in this together. This is why we either need to pool our risk in a national consensus of some kind to ensure that no unhealthy American is left behind. Or we need a better idea that I haven’t yet heard.
So I want to hear from a Republican who opposes anything a Democrat proposes regarding health insurance reform: What do you say to the 47 million Americans without access to health insurance? What do you say to the hundreds of millions of Americans who are not independently wealthy and rely on meaningful health security to remain healthy and working? I get that you want to give ‘em all a tax credit. I get that. I’ve read John Mackey’s 8 Whole Foods Half Healthcare reforms that would lower costs, and not a single one of ‘em solves the problem of access to insurance when you’re uninsurable. So what else ya got, Republicans, because a tax credit ain’t gonna cut it in terms of keeping 47 million Americans out of poverty and ensuring that all Americans have health security. But I get this sneaking suspicion that you don’t actually care.
In the meantime, the Affordable Health Choices Act (in the Senate) and America’s Affordable Health Choices Act (in the House) provide an opportunity to expand health security to millions more Americans. Consider contacting Lamar Alexander, Bob Corker, and Jim Cooper and encouraging them to support these bills.