“You may need to talk with your doctor about your prescriptions.”

I recently received a letter from my prescription drug insurance administrator with that sentence in bold above the body. The letter explains that as of 01/01/2014, the plan’s coverage of this particular (name-brand) medication will change. The administrator and doctor together must review the prescription to ensure it falls within the plan’s rules.

There is nothing in the letter specifically mentioning the Patient Protection and Affordable Care Act (PPACA), although one sentence does mention information that is “FDA-approved”. The FDA is, according to Wikipedia, part of Secretary Sebelius’s DHHS. Nevertheless, the effective date of the new policy is, I am certain, no coincidence.

Fortunately for me–and I am a fortunate person–this medication was for a specific short-term purpose, and I am no longer using it. I empathize with those who may not be so lucky.

Use the Power of Language, Part III



Well, Rhino-sized, anyway.

Apparently on Tuesday, the Senate Democrats decided to take the “SQUIRREL” of the poorly- or non-functioning HealthCare.gov site and inflate it to elephant proportions, to distract us from the story of millions of individual medical insurance policyholders having their policies cancelled because they do not meet the requirements of “Obamacare”, and this phenomenon being known to the Obama administration as early as 2010. This led to a whole bunch of tweets (on Twitter) that continually irritated me, because opponents of this law were using language promoted by proponents of it, rather than words that accurately describe what we’re talking about.

I sent out a few tweets about it, and I’ve decided to repeat and expand on those here.

1. The law that has been dubbed “Obamacare” is not the “Affordable Care Act” (ACA). It is the “Patient Protection and Affordable Care Act” (PPACA). Please don’t forget both empty promises when writing or tweeting about it.
2. What the law requires individuals to buy is not a “health plan”. It is a medical insurance policy.
   A health plan is a course of action intended to promote and maintain the health of an individual, created by that individual usually in cooperation with physicians and other advisors.
   A medical insurance policy is a contract wherein the buyer pays a premium in consideration of the risk that the insured will incur expenses due to certain treatments, which the insurance company will bear at least most of the cost of.
   The health coverage required by the PPACA is not so much a medical insurance policy as a pre-payment contract for scheduled services. Actually, many employer-sponsored “health insurance plans” are also that–especially the HMO type.
3. The arrangement where all medical services are provided by the State is not “single payer”. It is an “everybody pays” arrangement. Except, of course, for those who do not pay in to the system. People who receive benefits paid for only by other people are called “Free Riders”.
   (In my tweet, I mistakenly attributed my awareness of this term to The Czar of Muscovy, of the Antient and Noble Order of the Gormogons. It was actually this entertaining and informative post by GhettoPuter. I apologize to ’Puter–and as appropriate, to the Czar–for this error.)
   Considering what employer-sponsored group health plans have become, each one is a sort of micro-everybody-pays system. Not so bad, as long as they are voluntary. But what if participation were mandatory, and everyone were forced to pay for everyone else’s pre-existing conditions and routine personal maintenance, like contraception? Welcome to the PPACA.

Addendum: I also saw some video and quotes from Barack Obama being shared where he said that nothing in this law will force people out of their current policies, with the claim that he was lying. Technically, though, it appears that his claims may be true; it was the rules and regulations written by the Department of Health and Human Services that forced insurers to cancel those policies, rather than having them grandfathered in as acceptable. However, this is just another case of lawyer-ese, saying something that is technically true, while knowing the end result will be different.

So the Massachusetts Individual Mandate was to Promote Responsibility!

On On the Record Friday night, Griff Jenkins had a report on the differences between the Massachusetts medical insurance law (“Romneycare”) and the PPACA (“Obamacare”). Griff was talking to Eric Fehrnstrom of Gov. Romney’s campaign, and asked about how the individual mandate differed between the two laws. After mentioning the restrictions of the U.S. Constitution, Mr. Fehrnstrom said that the reason it was included in Romneycare was to address “a peculiar issue to Massachusetts.”

He described a situation where there was a “very small” group of people who refused to buy medical insurance, even though they could afford it. When those people went to the hospital or urgent care, the taxpayers would end up paying for it. Mitt Romney was so concerned with the principle of personal responsibility, that he took away their responsibility to decide to insure themselves by mandating that everyone do it.

What the hell would be wrong with just eliminating the State paying for people's medical care?! Make those people pay for their own services! If we wanted to promote personal responsibility, wouldn’t that be the way to do it?

Is it too late for me to get in the race?

Social Security and Medicare in the 21st Century

If you're age 55 or over, nothing changes. You get full benefits and continue paying the Social Security and Medicare (SS&M) taxes as under the current contract, or law.

If you're age 40 to 55, you have an option:

• pay 67% of current SS&M taxes and receive 50% benefits, or
• pay no more SS&M taxes, get a one-time refundable tax credit of 50% of those paid so far, and receive no benefits

If you're under age 40, you get a one-time refundable tax credit of all the SS&M taxes you've paid, and you are released from the contract. No more SS&M taxes, no benefits.

The percentages can be tweaked, but these seem pretty fair to me, and we all know that, even now, the benefits payable under these programs bear no relationship to the revenues collected as payroll taxes.

The Solution to High Healthcare Costs

Competition.

"But," you say, "there is competition already! We are free to choose whatever provider we want to see." Are you, really?

If you are not self-employed, it is likely that your health insurance is provided as a benefit of your employment. It is likely that your policy has a list of providers contracted to provide services at an agreed price. The phrase "usual and customary" really means "the price that the insurance company agrees to pay and the providers agree to accept." In other words, all the providers available to you effectively charge the same price. There is no competition there.

To bring true competition back to the health care marketplace, I propose as a first step that we do away with employer-provided health insurance. Insurers can still offer group plans, including some like the so-called "affinity" plans for social clubs, university alumni, and the like. People can choose to join one of those, or buy an individual policy as some insurers are offering now. The differentiators would be in what is covered and the limits.

To improve those options, I propose that we strongly discourage, if not prohibit, the price-fixing that is now called "usual and customary charges." In fact, I think price-fixing is illegal, and that is precisely what this practice constitutes. People could then shop around for providers they like that charge affordable prices. I realize that many people, especially younger people, make so few visits to the doctor as to make this difficult to do. Sure, one could ask prices over the phone, but that's only part of the story. Talking to friends and coworkers could help, or even referral services.

Please comment on this. And I hope you'll send all your ideas (they must be better than this) to your Congress-critters.