What I Don’t Get About the Patient Protection and Affordable Care Act

Like most Americans, a lot has been running through my mind since the Supreme Court ruling was released yesterday. Wherever you stand on the issue, yesterday was no doubt a historical day. That fact is not lost on Americans. As with so many other monumental days in our history, people are divided. What feels different to me in my short lifetime of experiences, is the level of dissention and the inability to be civil. The horrible language, name calling, and hatred that appears in the comment section of any blog post or news story (and sometimes it’s quite hard to tell the difference) is astounding. It seems when people get online they lose every ounce of composure. It’s really rather frightening to see how out of control people can get.

As I watched and listened to the coverage unfold I wondered what would happen if each person tried to say something in support of the opposing side. What if everyone against the PPACA could say one thing they like about it and those for it could say one thing they don’t like about it? What would happen? I think we would find some common ground. I don’t think half the country wants us to be socialists and the other half wants people who can’t afford health care to die. If you believe an eighth of the rhetoric out there, you would have to think this is true. It is never that simple. I think the reality is, there have been no civil conversations in the public arena about the pros and cons of the law. Only rhetoric and party lines tossed about with no willingness to discuss the meat.

I have questions about it. Things that concern me; things I don’t think will work. I have tried to seek out the answers and there don’t seem to be any. At least not any from sources I trust. Maybe that’s the key, no one has earned my trust by being willing to discuss the good and the bad. I thought today I would put my questions out here and see if there is anyone who can dialogue with me about them. Anyone who understands the ramifications of the law and how things will play out, who is willing to have an honest, respectful conversation. So here goes.

Personal responsibility

I believe there are two kinds of people who don’t have health insurance. Those who can’t qualify or afford it and those who, for whatever reason, choose not to have it. My question is around the second half. There are plenty of Americans who think they won’t get sick. “That won’t happen to me.” They are healthy and don’t choose to spend their money transferring that risk to an insurance company. Or they are lazy and simply don’t want to be bothered. I refer to that as personal responsibility and people have the choice whether to take it or not. Those who don’t are fine with letting someone else fix their mess. It is not unlike those who buy a house they cannot afford and then want to be bailed out rather than lose the house. Some people choose not to be responsible for themselves and allow others to carry that burden when it does “happen to” them. But how do we legislate them in to taking personal responsibility? Because if we can, this is just the tip of the iceberg. Will we pass legislation to mandate all forms of personal responsibility? And who will be the judge of what is responsible? Will there be a limit on the size of house I can buy? Will I be mandated to drive a certain car to avoid over extending my self? I get that this sounds foolish, but I believe you have to carry this kind of concept through to the extreme to see where it could go “in the wrong hands”, where could it lead, what precedent have we set? I feel like this becomes a slippery slope. I fully understand there is a cost associated with others not taking responsibility and one of the goals of the PPACA was to alleviate that burden on others. But can we really do that? And how else will we legislate responsiblity?

Insurance is a way to transfer risk

The entire premise of insurance is that I will give you money (premiums) in exchange for you agreeing to pay if/when I need medical care. It is a business. Thousands, probably millions of people are employed in some way by the insurance industry. It is not an evil entity; it is an industry full of Moms, Dads, brothers, sisters, aunts and uncles working to support their family. It is businesses that are invested in by millions more Americans. My retirement portfolio is probably invested in insurance to one degree or another. That means if insurance companies don’t make a profit, my retirement savings doesn’t grow. I am counting on the money I invest in my retirement growing and compounding over the next 30 years until I retire. {It goes back to that personal responsibility thing – I don’t choose to rely on Social Security to take care of me in my retirement years, I’m planning ahead to take care of my self.} Thank goodness there are companies who are willing to take on the risk of my health so I don’t have to. Thank goodness for the insurance industry that employs millions. Sorry there isn’t a question there, I just needed to make that point.

Pre-existing conditions

Hallelujah that someone with a pre-existing condition can change jobs or choose to stay home to raise their children without the fear of losing insurance driving all their decisions. I think this gives people freedom. And I love that! There shouldn’t be a life sentence because you, or someone you love,  happened to draw the short straw in the health department. What I don’t understand is how people believe this will not raise the cost of health insurance for all. The idea behind insurance is the gamble of estimating what an insurer will have to pay out for any individual over the course of the policy. The premiums are based on those best guesses. If I know ahead of time that your illness will cost hundreds of thousands, if not millions, over your lifetime, would I not have to charge more? What kind of business model would not cover that?

Level premiums for all

It’s a nice idea to think that no one should be charged more for their insurance. But this goes back to the idea that insurance is a business and as such must have a model that makes a profit. If not they won’t be a business for long. Why is it not ok to charge different premiums for different levels of risk? As a woman, there are some health issues I have the potential to face that men do not. That’s reality. So why would it be wrong to charge more for my coverage; the person with a higher risk. If that is the precedent, I’d like to have a reduction in my car insurance premiums since I pay more having teen boy drivers. I call not fair! When did the “right” thing become synonymous with “everyone is equal”? I think this is the part that makes people cry socialist. When the standard is set that the expectation is all are equal. Then all jobs should pay equal, then socialism. Do you see why people would be concerned by that? Can we acknowledge and talk about that?

Elimination of lifetime caps

This is another piece that is incredibly important for those with chronic disease. Often the annual or lifetime limits can leave them capped out in their 40s with no options. That is a scary place to be and offering the security of no caps is incredible! What I don’t trust is the sustainability of the plan. I think of it like Social Security that seemed like a great solution, until the numbers drawing out surpassed the numbers paying in. It isn’t a sustainable model. With people living longer is this sustainable? I would love to know that it is.

Spreading the burden

There has been much talk about the penalty (now redefined by the Supreme Court as a tax) that anyone without health insurance will have to pay. I understand that all Americans who don’t purchase insurance on their own will pay this fee of 1% -2.5% of their income. I believe the idea here is to help cover the costs which we currently all absorb in the form of higher health care costs when someone goes into the emergency room without insurance. So will the individuals without insurance, who have paid their penalty/tax be treated? How will this begin to cover the costs. {For example a young 20 something making $40,000 a year doing factory work doesn’t think he needs insurance. He chooses to pay the fine of 2.5% of his income. That’s $1000. He has an appendicitis attack, goes to the emergency room and ends up having surgery. I don’t know what that would cost, but I do know it would be more than the $1000 penalty/tax he paid.} Those who don’t want to pay this penalty/tax will get out of it just like the deadbeat parents who get by without paying child support, by hiding assets, working for cash, etc. How will this be different? How will this ultimately bring down the cost of healthcare? And will it disincentivise businesses to provide health care to their employees? If the penalty is less than the cost of insurance premiums will employers simply decide not to mess with offering insurance coverage to their employees?

There is good in the Patient Protection and Affordable Care Act. There are things in this legislation that will be positive, especially for people with chronic illness. There is also a great deal of ambiguity in this legislation. There are lots of things that set a precedent for a direction that I’m not sure the American public has determined should be our future direction. There are so many questions unanswered. Could we just have a dialogue about the law? A civil, respectful, honest conversation?

This blog is my little corner of the world-wide web. The ideas and opinions posted here are mine and mine alone. I don’t purport to speak for anyone else or promote anyone’s agenda. The comments section is a place for me to dialogue with my readers and I hope we will have some good conversation. As my little corner of the web, I get to choose the rules – kind of like being the Mom. I choose to have this be a positive, respectful, thoughtful place. Comments that do not fit that criteria will be removed. {Please note, the first time you comment on my blog I have to approve your comment. Subsequent comments will appear immediately.} I would challenge you to do as I said at the beginning of this post and say something that reflects an understanding of the other side of the debate. Show that we can disagree, but we can also find points of agreement. Thanks for stopping by and I hope you come back again – my posts are rarely this heavy:)!



Filed under Health, The State of Affairs

6 responses to “What I Don’t Get About the Patient Protection and Affordable Care Act

  1. You could have just lifted that from my brain. You and I share the frustration of the uncivil attitude shown on both sides of this issue. I am about ready to unfriend a few people on facebook for being so hurtful in how they are treating those with different opinions. These are people who are always telling people that we need to accept everyone for who they are. *shrug*

    I like some parts, like the no pre-existing conditions, having your child eligible on your insurance until 26, and no cap. We’ll need those for Anna. I am nervous about the mandate nature of the insurance. Any time there is an unfunded mandate, it seems to be incredibly expensive. I worry about the parts that no one understands – including those who passed this legislation. What will be the long term pros and cons? Will my children be saddled with the costs associated with this mandate when they are trying to start families of their own? Too many unknowns for me to get behind this one.

  2. amy kruse

    This was pretty heavy Judy 🙂 But thank you, considering I haven’t paid much attention to any of this in the media, I appreciate your perspective and feel a little more educated now. Thanks!

  3. Jan Rhind

    Very thoughtful, Judy. I appreciated the preface to the questions. We, as a country, have lost the ability to discuss difficult issues with civility. I like you idea about each “side” finding one thing to say about the opposite perspective. Jewish Talmud scholars do that sort of thing all the time with the understanding that the vigorous debate is made richer and offers more insights when that happens. The idea is to enrich the discussion, not shut it down.

    I also like your questiions and the commentary on them. I think your questions are questions shared by many.

    I do encourage people to relax a bit. Keep your eyes and ears open as all of this gets sorted out. And stay cool – have a nice icy drink of your choice and chill out. It’s better for your health than getting all hot and bothered

  4. I have questions that I haven’t been able to find online and you mentioned a lot of them. I agree there are some elements in the PPACA that can benefit others and do need to addressed (like not discriminating based on pre-existing conditions) but it will be definitely more expensive overall for everyone.

    Like you, I have been reading lots of articles and what worries me the most is all the doctors/nurses/medical field workers who are leaving comments about how worried they are about what this will do to the amount and quality of services they are able to provide. I’m assuming that’s because they believe insurance companies will begin lowering the amount they’ll allow hospitals to charge to bring down their cost (especially now that lifetime limits have been lifted)?

    The other area that is bringing large families or those with expensive conditions worry is the cap now being put on how much you can put in an FSA without it being taxed. The limit is $2,500 so those who have large co-pays will have much more to pay out-of-pocket and they can no longer reap the benefit of the money being pre-tax.

    Thanks for presenting your thoughts & questions in such a peaceful and well thought out way! Always appreciate honest but thoughtful commentary.

  5. Judy, as always your thoughts are well-organized, logical and relevant.

    I think most of what passes as dialogue on the internet is in the vein of what you described.Sadly,a filter is lost when you don’t have to face the person you are “talking to”.

    I have similar questions surrounding the rising cost and long term sustainability of this plan. I also see lots of good ideas that should be implemented.

    My one big issue is on principle …it is the tax, er “penalty” involved. The government (specifically congress) has long used its taxing powers to regulate the population’s activity/behavior. Whether I agree with using the power in this way in general or how it has been implemented specifically is irrelevant. It is within their constitutional powers.

    Now here is the rub: to date, this power has been used to discourage activities: these are better known as soon and luxury taxes to the public – more genetically a usage tax. We see these taxes on tobacco products, alcohol, gasoline, cars over $45k (I believe that is the current threshold), boats over a certain price, etc – the government using its taxing authority to discourage behavior. This penalty/tax however is quite different. This tax (let’s call a spade a spade, folks). It is not activated when you do something that has been deemed unsavory, but deemed if you DON’T do something the government wants you to do.Previous examples I gave, you are not taxed for inactivity, only once you take action. This one inactivity prompts the tax…you have to do something to Avoid it…

    Sure the argument can be made that not getting insurance is an action, and the act of not choosing is action in itself, but that misses the point of the distinct difference between taxing beats taxing inaction. This is the argument I would choose to take to silly extremes to make a point.

    So I will leave my thought, not many to be a soapbox, with this. I feel horrible for those that cannot afford insurance and welcome theopportunity this provision provides for those people. Additional, I abhor those irresponsible people that can but chose not to invest in their health, and expect a bailout when they do need medical services. I am excited that those with our existing conditions can’t be denied coverage, but think it naive to think that this won’t translate to higher premiums for everyone at some point.

    With any complicated bill, there is good and bad. With change in this scale there is going to be resistance. But as Just said, civil, thoughtful and open-minded dialogue should prevail.

    Thanks Just for your thoughts.

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