Health care is a mess

As we enter yet another chapter in the “repeal and replace” struggle currently confronting Congress while the Affordable Care Act encounters another political vivisection, it has become more apparent that “facts” are being tossed out with little concern for their veracity.

 

The rallying cry of the Democrats – that 24 million Americans would lose their coverage with the Republican-crafted American Health Care Act – is completely fictional.

First, there are, at most, 11 million to 12 million individuals whose policies would be under fire, and, more to the point, annually nearly 5 million Americans move in and out of some health care plan.

More disconcerting is the invincible ignorance of most Americans about how the insurance industry actually works.

Going back to its roots, it can be traced to the Civil War when companies began to sell “accident” insurance. Later, the Great Depression accelerated the sales of policies to cash-strapped families, and Blue Cross was born.

Physicians seeing the inevitability of a single-payer system inaugurated Blue Shield, and 50 years ago, Medicare and Medicaid legislation was enacted. Children’s Health Insurance Program for low-income families with children was enacted 20 years ago.

But insurance remains insurance, and the companies that sell it are for-profit organizations. To make money in this business, you have to enroll enough low-risk clients to offset those with higher likelihood of spending your money. This is where the conflict between mandatory health insurance coverage and those with pre-existing conditions collides.

For insurers to afford to spend money on patients with chronic health problems, they have to include in their rolls many healthy patients unlikely to use their health plans in the foreseeable future – hence, the ACA’s individual mandate.

Imagine that you are in the business of selling automobile insurance, homeowners insurance or business insurance. If your next clients had multiple at-fault auto accidents or cigarette-related home fires or lousy business practices, would they be subsidized by a federal agency? Not likely.

The notion of not denying health care coverage to individuals with pre-existing health conditions certainly is laudable. The issue here is the rate that such individuals should be required to pay and not be a burden that crushes those who lead medically responsible lifestyles or for many years underwritten health care expenses of those whose choices and lifestyles have been different and resulted in poor outcomes.

Lawrence Devoe

Augusta

 

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