|One Kaiser Plaza, Oakland, CA. Headquarters of Kaiser Permanente.|
I think I posted a while back that today is the last day I will have comprehensive health care coverage. For a little over a year when I am eligible for Medicare, I'll be on my own.
I have been covered through Kaiser Permanente for the last 25 years or so, very rarely using their services but comforted by the knowledge that it was there if I needed it. I didn't realize how costly it had become until the COBRA statement came saying that to maintain the coverage we have would cost close to $3,000 per month. Oh really. Isn't that something. At Kaiser??? Eeek.
Well, after considering the risks/benefits, the costs, and the fact that we would soon not be anywhere near a Kaiser facility, the answer was "No thanks." Other COBRA plans were available at $1,500 a month and up, but they didn't seem worthwhile either -- high deductibles, limited coverage, rather pointless, really.
Thankfully, while I've faced some life-threatening illnesses, I don't have a chronic condition that requires continual treatment and care -- at least not yet. The debilities of age do seem to be creeping up on me, but I've been able to manage them on my own well enough up to this point... let's hope it stays that way.
Interestingly, while medical coverage was hyper-expensive (I have no clue how older workers -- or ex-workers as the case may be -- are supposed to manage such huge COBRA bills to maintain coverage), dental and vision coverage were made available at no cost. So there's that.
I don't know that the ACA would actually have any positive effect on this situation. COBRA would still be available, but it would still be out of reach financially -- at least so far as I've been able to puzzle out the limited information I've seen. If there really is a 6% of gross income limit on health care insurance costs to households, then that actually would make a big difference, but nothing is in stone until it is graven there, and nothing will be graven until after Decision 2012 concludes.
The notion that the First Thing President Romney Will Do is "Repeal Obamacare" is patently absurd, of course. Having seen this man's ways for a while, what he will do First is to sell the rubes on the kabuki that he will be conducting from day one. He has no intention of repealing Obamacare -- it's too lucrative to his owners and sponsors. Besides, despite his August Pretensions, even he doesn't have the power to "repeal" it. Not that he would want to. He might be inclined to suggest changes to the program that increase costs and limits coverage to individuals and households, but otherwise he will leave it pretty much alone. The Industry won't let him muck with it very much.
On the other hand, if Obama receives another term -- which is looking more likely, his political instincts are still astonishing -- he would probably be inclined to tweak it in a similar direction, simply because that's what he does. If an R suggests "improvements" he's right there. So. ACA or nothing, that's what the nation is going to be stuck with.
I've dealt with Medicare and Medicaid on behalf of others in the past, and as long as you can get care, they're fine. The problem is getting care prior to a crisis -- or even in a crisis in some cases. I've spent up to 12 hours in an ER waiting room with a Medicare patient before any sort of treatment at all was offered; and of course once she was seen and treatment was begun, she was in dire shape.
Who would have thought.
There was no cost to the patient for Medicaid treatment, though now there are small co-pays for doctor visits and much higher ones for ER visits (of course, when the doctor refers you to the ER, what are you supposed to do?) Medicare co-pays are still something of a mystery to me. At no time was anything out of pocket demanded, but costs beyond what Medicare reimbursed would be billed to the patient up to certain limits. I still don't quite understand how it worked, though. Nevertheless, I am well aware of all kinds of shady billing practices by providers. Rick Scott is only the tip of the iceberg. It seems like every provider engages in bill-padding at the very least, frequently much worse.
There are nowhere near enough providers and facilities to accommodate a large influx of new patients, and it has long been my impression that the basic idea of the ACA is to get payment now for future medical care -- that quite likely will not be available. It certainly won't be in the short term. This will mean that people will be "covered" for treatment they can't get. Brilliant!
As I understand it, money for more community care clinics is being fervently stripped out of the ACA. These clinics are an important step in expanding access to care, but if the money is being stripped out as we speak, it's patently obvious that expanding access is not on the agenda, not that it truly ever was. If I recall correctly, Bernie Sanders was the one who demanded the clinics, and he was bought off with promises that have been relatively meaningless ever since. If there is little or no access to care due to lack of personnel and facilities, regardless of coverage and subsidies and all the rest of it, then it's pretty obvious that the whole Rube Goldberg contraption of the ACA was never meant to do much more than keep the insurance cartels and the medical industrial complex in profits forever.
Yes, I'm cynical about these things.
From the beginning the correct solution to America's medical care crisis was expanding and improving something like Medicare for All. This is not rocket science, this is obvious, and it was obvious when the correct solution was never on the table let alone considered that the point of the ACA was profit for the medical cartels. Period. If somebody gets medical treatment they otherwise wouldn't, oh well!
The correct solution was to remove the middle-man cost and inconvenience burden of insurance companies, simplify, streamline, make care available, tax to fund it, aggressively expand professional training, and provide an extensive network of primary care facilities. The correct solution was to put all of this in the public sphere, as a public health matter, rather than expanding private, for profit health care.
This has all been known for decades.
And yet the Health Care Reform panels never even heard let alone considered the correct solution.
Ah, but ACA is better than nothing!
The question is for whom?