By Bernie Fetterly
Ithaca (N.Y.) Journal, March 9, 2012
We know that the Affordable Health Care Act was written by the insurance companies for the insurance companies. It does not deal with the rising cost of health care and it increases under- insurance for just about everybody. Also, 23 million Americans will remain uninsured. Can we really wait two more years and still have a bad health care plan that will cause many to die needlessly and also cause many to go bankrupt?
President Barack Obama is trying to make his bad health care plan look good in his campaign for re-election. We may be forced to re-elect him, but we should not make the mistake of thinking his Affordable Health Care Act is a good one.
Unaffordable under-insurance
Americans are being confronted with the emergence of a new stage in America’s downward slide on health care. “‘Unaffordable under-insurance” is rapidly becoming the new standard in the United States.
One of the most telling symptoms of the “new normal” is that visits to physicians’ offices have dropped a stunning 17 percent from the second quarter of 2009 to the second quarter of 2011, according to a recent Kaiser Family Foundation report. This drop illustrates how the ever-growing burden of health care costs — in the form of out-of-pocket deductibles and co-pays — is making Americans reluctant to seek care despite having the supposed protection of health insurance. We know that a lot of people are foregoing beneficial treatments for conditions such as diabetes, or not getting vital preventive services such as Pap smears. It’s scary.
As people’s health conditions deteriorate because of a lack of preventive care, the eventual cost of treatment will be much more costly and the chances of a healthy outcome reduced. With high- deductible insurance plans proliferating among pattern-setting large employers, a pattern of unaffordable under-insurance will be well-established by the time the Affordable Care Act, which will include state-level health care exchanges, is fully implemented in 2014.
The various levels of coverage offered under the ACA will leave working families with the same problem of increasingly skimpy insurance coverage that is too expensive to actually utilize.
The “bronze plan” will have an “actuarial value” of 60 percent, meaning that people will be paying 40 percent of their health care costs. Government subsidies and maximums on out-of-pocket costs will provide some assistance, but it still appears that the “bronze plan” will mean that consumers pay about 40 percent.
“The silver plan” covers 70 percent (in other words, it does not cover 30 percent) of health care costs, but the premiums will be higher and most consumers will probably be drawn to the bronze plan. But there is little likelihood that health insurance premiums will remain stable under the bronze plan or any other option under the new federal legislation.
Even with usage of insurance declining, fueling huge profits, insurers in California and elsewhere have been jacking up premiums. Corporations have been able to force workers to swallow the premium increases, with workers’ share of health care costs rising 63 percent between 2003 and 2007. With no effective cost controls contained in the Affordable Care Act — which, after all, was drafted by Wellpoint insurance lobbyist Liz Fowler working alongside the insurers’ pets in Congress — the problem of “unaffordable under- insurance” is only going to snowball as we enter the new era of “reform.”
Disappointing so far
While the ACA has raised hopes that some of the worst abuses of the for-profit insurance industry will be curbed, most “improved Medicare for all” supporters caution that insurers are likely to circumvent regulations and that the ACA won’t be able to keep health care affordable.
The much-vaunted insurance regulations — for instance, ending denials on the basis of pre-existing conditions — are riddled with loopholes, thanks to the central role that insurers played in crafting the legislation. For example, the ACA’s program for people with pre-existing conditions has enrolled a mere fraction of those expected to sign up, as insurance remains prohibitively expensive.
Many single-payer (“improved Medicare for all”) supporters say we appear to be headed toward a new health crisis in which most people find themselves among the ranks of the “unaffordable under-insured” and health care is increasingly delivered in a rigidly tiered system based on ability to pay.
Poor people depending on Medicaid will be especially hard hit as the cash-strapped conservative governors and some Democrats slash Medicare and Medicaid rolls. The limitations of ACA-style reform — which the Obama administration chose to build around the mammoth and unproductive bureaucracy of the for-profit insurance industry — are becoming increasingly apparent.
Some of the most highly-touted features of the ACA features contain built-in problems, Physicians for a National Health Program leaders noted last year. For example, older people can be charged up to three times more than their younger counterparts, and large companies with a predominantly female workforce can be charged higher gender-based rates at least until 2017. Moreover, about 23 million people will remain uninsured nine years into ACA’s existence.
At the same time, the affordability and coverage of those with insurance will continue to deteriorate until the bottom 99 percent start to rebel against a health system shaped to maximize the profits of insurers who seek to minimize care. The Occupy movement offers a hopeful sign that Americans are recognizing that the health care system, like other U.S. institutions, functions to benefit the top 1 percent at the expense of the vast majority.
Health professionals from PNHP say the downward spiral in health care will finally end only when the United States installs a Canadian-style “Medicare for All” single-payer system. It is ideal for the United States, with its very large risk pool, which includes the rich, the middle class, the poor and the elderly. The solution is to have everybody involved and working together.
Hopefully, Obama will change once re-elected, but we don’t have to believe and should not believe that the Patient Protection and Affordable Care Act is a good health care plan for America. A single-payer plan is what we need; it’s a job stimulus and it saves billions of dollars. We can do better. We have to do better.
Bernie Fetterly is director of the Tompkins County Health Care Task Force.
