Sunday, May 7, 2017
Healthcare Studied -- Finally
When the ACA/Obamacare was first passed, the bill was over 2900 pages long and nobody in the Senate, at least, had read it all the way through. I don't recall offhand the name of the politician who said that they had to pass the bill to find out what was in it, but she was a political idiot. Would you dive off a cliff in the dark just because some charming speaker said 'Trust me'? Ah, but the Liberal euphoria at having elected Our First Black President distracted Congress from all those citizens complaining "Just Fix Medicare".
It was the bureaucrats tasked with the details of making the new law work who noticed the several little bits of political pork hidden in the nooks and crannies of the bill, such as a gift of $100 million to repair the infrastructure of... Gaza. The law they finally put into operation was *only* 2100 pages long, and none of the media were so rude as to ask exactly what was in those missing 800 pages.
It was the army of medical finance accountants who began noticing problems with the new law, and issuing alarms, which government and media took care to ignore. People who noticed and spread these warnings were usually denounced as "right-wingers", "racists", and worse -- as if criticizing what was considered the crowning achievement of Obama's administration was blasphemy, much like any criticism of Islam.
Only after the election, when Trump started his attempts to replace the ACA, did it finally become acceptable to seriously question our current system of public healthcare. As it turns out, there's a lot to question.
The first federal public healthcare system was the Veterans' Administration, which was obliged to provide free hospitals and medical treatment for veterans, and did a repeatedly bad job of it. The Bureau of Indian Affairs did something similar for the Indian tribes. All that could be said of these free hospitals and clinics is that they were better than nothing. There actually was a bill passed in the 1970s that would have provided the same services for the definable poor, but a concerted campaign by the AMA and associates kept the bill from ever being funded. That law is still on the books, forgotten and still unfunded.
Medicare was passed in the '60s, and was intended to be the safety-net health insurance system for the poor, funded out of Social Security, which would pay directly for medical treatments. Medicaid was intended as a supplement, to fill in the gaps in the system, but has turned out to be a trap; any mistake in the complex paperwork -- regardless of whose fault it is -- can result in its clients being robbed of everything they own. Any social worker with any sense today warns their clients to apply for Medicare, but avoid Medicaid like the plague.
The major problem with Medicare was that in providing direct payments, it cut the health-insurance companies out of the loop, and out of all that juicy money. No one in particular has every been prosecuted for this, but the insurance companies entered into a conspiracy with the medical industry to exploit a particular loophole in the law; any medical practitioner could refuse to accept direct payment from Medicare, so that the Medicare money had to be diverted through middlemen -- certain health-insurance companies that were favored by the state governments -- and the insurance companies would then pay the medical providers, who gleefully accepted those payments. This system did nothing to reduce medical costs. More, the insurance companies would pay only 80% of the costs, leaving the clients to pick up the other 20% in co-pays. And never mind the added costs created by the paperwork itself, which deserves a whole article of its own. The ACA only increased these costs, building up a snowballing debt, which is what those accountants tried to warn the public about.
Put them all together, and they describe a system built to fail.
Yes, the ACA has to go, Medicare needs to be severely overhauled, Medicaid should be thrown out completely -- and, incidentally, both the Indian-reservation and the VA hospitals and clinics need to be reorganized from the ground up. The various regulations have to be simplified, the paperwork must be cut to the bone, and the bureaucracy with it. Most of all, those middleman insurance companies must be cut out of the loop. Medicare payments must be made directly to the medical providers -- hospitals, pharmacies, clinics, doctors and all -- and there must be some federal enforcement to keep them from refusing those direct payments. Possibly the fed.-govt. could take away the license to prescribe medicines from any refuseniks, which would cut drastically into their incomes. Also the FDA has got to be overhauled -- and marijuana re-scheduled as an over-the-counter medicine -- and the whole drug-approval system re-examined, but that's a different can of worms and needs a bill of its own. The health-insurance companies can continue to offer their services to the public, but they won't get an automatic slice of the taxpayers' money through Social Security via Medicare anymore. They might even have to compete honestly for the market, which will mean improving services and cutting costs like any other business.
The problem with getting to a sensible bill like this is that not only will the insurance and pharmaceutical companies scream bloody murder, but the rich reactionary-conservative faction wants to inject its own politics into the healthcare system. They don't just want to de-fund Planned Parenthood (which, frankly, survived quite well on private donations for nearly a century before Medicare began paying into it), they want to ban all abortions, all fetal-tissue research, and even all contraception -- which the majority of the citizens will never stand for.
Now, these groups contributed heavily to the GOP in the last election, so Trump has to at least make a convincing show of trying to please them. Of course, he's already done that with his first attempts to replace the ACA, which famously failed, so he can convincingly say to the reactionaries and insurance/medical/pharmaceutical companies that he's done all he could to please them -- and then he can go on to more sensible attempts at healthcare reform. The current bill will probably fail too, and then he'll have to come up with something better yet. No doubt he knows this; he's not a stupid man.
Meanwhile, just about everybody in the federal government is -- finally! -- studying the federal healthcare system with a magnifying glass, going over all the laws with a fine-toothed comb, looking to clean up the whole mess -- everything that should have been done before the ACA ever passed. It's more than a shame that this took so long.
In any case, yes, the ACA will eventually be repealed and replaced. It's just a question of when, and how well.