It’s simply a matter of
fairness. Do we owe it to our neighbors
and future generations (e.g., children’s children), to have a broad and
effective health care solution? One that
citizens can afford to contribute to, and one that the economy can afford to provide without
detracting from its wealth generation infrastructure. Prior to ACA (aka Obamacare), the private
sector solution left a hole in needs for tens of millions of hard-working
Americans. Yes, many poor and unemployed
and elderly people were also uninsured, but there were also far too many people
not that different from you and me.
Capitalism as a solution is a false comment. As we discovered years ago during the financial crisis, and last month, with the bloodied
removal of passenger Dr. Dao from a United Airlines flight. Dozens on our website noted that so too is a
centralized government solution (e.g., the crooked Veterans Affairs hospital system is among a legion of eventual and epic government fails). Victors of the free-market system myopically point to
their success and desire to maintain that way of life. While more moderate detractors appreciate
that this American system only works when the incentives are guided. Yet guiding incentives implies some degree of
a free-market not being 100% free through every prism of observance.
Again, this comes back to
overall fairness. Looking at both your
heart, and your wallet. Being both compassionate,
and prudent. What’s curious about the
ACA plan, which the House of Representatives this week tried to repeal, is that
it tries to address the gaps in our country’s health care system. Are those changes wiser? We were among numerous people knowing years
ago that the current ACA was actuarially unsound. A law forcing far too few people pay a small
amount to cover the high-risk ailments of mostly elderly, poor, and sick people. Sold as insurance, it instead resembled a
pyramid tax scheme to population-share the health care burdens of a small
number. Americans were at first opposed to this plan, voting Democrats out in 2010. And yet no one got rich by it either, simply for seeing their doctor.
And still, we are left years
later with most Americans around the country, and across age groups, who are
seriously under-covered for their health care needs and can’t afford to
purchase more. They are still on the
brink of bankruptcy from the nagging deductibles alone, and prohibitive premium spikes when wanting to switch insurance plans.
Of course, they should have bought a higher metal insurance plan (as
well as take care of themselves a lot better), but however we got here, the
plans being selected (per Department of Health data) is mediocre.
Mediocre health care coverage
seems to be something that is as good as we are going to get for some
time. An acutely troubling area of
health care insurance buying decisions is how ¼ as many catastrophic plans are
selected versus platinum plans. Catastrophic
coverage is barely insurance that anyone would use (which is why you pay so little for it!) It is literally a toss-up for some between
that or being forced to pay a tax penalty.
No one (at any age)
should be buying this and thinking it will be around for most of their health
care needs. Yet we see more than half of
the insurance buyers are <45 years old, and across the country (excluding New
York and California) there are far more catastrophic plans procured versus
platinum. Why does this matter? This means there is less of an active actuarial
pool to amass and invest the premiums in advance of you needing it to pay for
more serious ailments and future pre-existing conditions these Americans want
later in life when they flip in greater numbers to the higher-level metal
plans.
This is one of the reasons the
entire actuarial model for the ACA is rapidly buckling under its own weight,
and premiums are further wedging people out of these higher metal plans. Invest in your longevity (here, here, here), find a way
to purchase the platinum plan, which is as close to real insurance coverage as
can be found in America. And this is a
bit diplomatically sensitive, but perhaps introduce some lifetime benefit
limits (maximums) on coverage for Americans.
Bringing the costs down for most Americans, yet being fair to sharing
the burden and affording as much health care as we can in this country. It’s all about fairness.
More choosing catastrophic:
Combined with less availability of higher-metal plans:
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