Step into Karoli's HCR Complaint Department

Update: The following complaints actually come from Investors' Business Daily, the same organization that lied to everyone back in July before the disastrous town hall meetings.

While I expect wailing and gnashing of teeth from the right wingers, I do get frustrated with it from the left side of the fence, mostly because that's the side I sit on. I got a list of complaints tonight that reads like a list of right wing talking points, so I decided to open the complaint department for questions, answers and debunks. There were so many in one post it would take a small book to address them all, so I'll start with the ones that seem to be causing migraines in fellow liberals.

The Mandate

You are young and don’t want health insurance? You are starting up a small business and need to minimize expenses, and one way to do that is to forego health insurance? Tough. You have to pay $750 annually for the “privilege.” (Section 1501)

Here is a fact: The only way you have universal coverage is to require everyone to have coverage. The only reason this bill isn't universal? Republicans said undocumented workers did not have the right to purchase insurance with their own money through the exchange, and you get to opt out if you choose to pay a penalty instead.

Sorry, young 'un, but there is no such thing as health insurance, per se. There are "risk pools". Risk pools represent a group of people - healthy and unhealthy - who all throw money in the kitty and then take it out when they need it. Insurance companies turn a healthy profit by cherry-picking individual pools for the healthiest in the bunch and booting the rest out. That's how you end up with stories about people getting sick and being tossed off their policies (like I was) or simply being denied altogether.

This bill, above all else, says people in this country are equal, and deserve to have equal access to affordable health insurance. To that end, the bill has been set up so the guy just setting up his business gets a 50% tax credit in 2014 to offset the cost of buying health insurance. That's not so bad, for a number of reasons, not the least of which is this: It makes that guy's small business competitive with the bigger business down the street that offers health insurance benefits.

What exactly was it you expected from health insurance reform? Single payer? Here's a news flash: Single payer carries a mandate, too, and it would be substantially more than $750 per year to pay for it. For all the positives, a Medicare buy-in for older people was estimated to be around $600/month, as opposed to the $1200 or so a year that a low-income person will likely pay for family insurance.

So you say, the mandate sucks. I say, then don't opt out. Get something for your money. Hell, the government is covering part of the cost, and there are some serious cost controls built in. The opt-out is silly. You're betting against inevitability.

Ok, on to the next.

How risk pooling works

You are young and healthy and want to pay for insurance that reflects that status? Tough. You’ll have to pay for premiums that cover not only you, but also the guy who smokes three packs a day, drink a gallon of whiskey and eats chicken fat off the floor. That’s because insurance companies will no longer be able to underwrite on the basis of a person’s health status. (Section 2701).

Boo hoo. Haven't you been paying attention over the past year? Insurance companies would *love* to underwrite on the basis of a person's health status. Imagine a slightly different scenario that looks like this:

You are young and healthy and want to pay for insurance that reflects that status. You pay next to nothing for your insurance. One day you come down with what seems like the flu, but it doesn't go away. You spend the next 2 months trying to find out what is causing your weight loss, fatigue, and stomach pain. Finally, you get a diagnosis: Ulcerative colitis and emergent type I diabetes. You are 20 years old.

That's a real scenario, my friends. That's what happened to my son. He didn't drink a six-pack, eat particularly badly, was athletic and active when he was hit like a ton of bricks. This is the reality: you don't know when you might get sick, and illness is not always related to lifestyle. That beer-drinking smoker might live to be 95. The odds are not in his favor, but he might. Conversely, you, the young and the healthy, could find yourself needing a whole lot of that pooled kitty long before your time. God forbid, but it happens every day.

Memo to the young: You are no more immortal than anyone else.

What? Unlimited coverage?

You would like to pay less in premiums by buying insurance with lifetime or annual limits on coverage? Tough. Health insurers will no longer be able to offer such policies, even if that is what customers prefer. (Section 2711).

Yes. This is true. Are you willing to put a maximum price on your life? What should it be? 10 million? 1 million? 3.5 milion? Have you priced medical care lately? The whole point here is to actually NOT put a price on life, but to make sure all citizens in this country have the care they need when they need it. This is somehow a bad thing?

Aw, gee. You have to actually get value for what you pay for.

I call the next group the "I live for me and no one else" group. This is the attitude that wants to deny the reality of pooling risk by claiming blazing individualism. Sorry. Repeat after me: Health insurance is really pooled risk. Repeat it again. Then remind yourself that prevention saves money by -- remember this one now -- reducing overall risk.

Think you’d like a policy that is cheaper because it doesn’t cover preventive care or requires cost-sharing for such care? Tough. Health insurers will no longer be able to offer policies that do not cover preventive services or offer them with cost-sharing, even if that’s what the customer wants. (Section 2712).

News flash: Preventative care saves lives and money. It makes the risk pool carry less risk. It's the right thing to do. It SAVES money. SAVES. Why would you want to make the costs higher?

You are an employer and you would like to offer coverage that doesn’t allow your employers’ slacker children to stay on the policy until age 26? Tough. (Section 2714).

Wow. Got kids? Mine work for a living, only I have one who is uninsurable. Those slacker kids make things cheaper for everyone as a rule. Some don't, like one of mine. My other one does, though. The more youngers you keep in the pool, the cheaper it is for EVERYONE. Everyone. Insurance 101, friends.

Do you want a plan with lots of cost-sharing and low premiums? Well, the best you can do is a “Bronze plan,” which has benefits that provide benefits that are actuarially equivalent to 60% of the full actuarial value of the benefits provided under the plan. Anything lower than that, tough. (Section 1302 (d)(1)(A)).

That's right, because it's been proven over and over again that anything lower than that is worthless underfunded insurance causing people to declare bankruptcy and lose their homes when they can't make up the difference. This fixes one of the biggest problems we have today: underinsurance.

Enough with the whining about buying stuff you don't know you'll need 

You must buy a policy that covers ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services; chronic disease management; and pediatric services, including oral and vision care.

Um, yeah. Because you just never know when you might want to get married, have kids, and need a psychiatrist, not necessarily in that order. Are you starting to really understand insurance 101 here? You pay ahead of when you need. Easy as that. No one -- not even young, invincible young people -- know when fate, love, or catastrophe will strike. No one. And not one of us is immortal.

You’re a single guy without children? Tough, your policy must cover pediatric services. You’re a woman who can’t have children? Tough, your policy must cover maternity services. You’re a teetotaler? Tough, your policy must cover substance abuse treatment. (Add your own violation of personal freedom here.) (Section 1302).

See my note above. Maybe you're not married now but you might be tomorrow. Maybe you can't have children but you have high blood pressure. Maybe you don't drink or do drugs, but you have a problem with obesity. We are all in this life together. We all carry risk. All.

That's it for this edition of the Complaint Department. I'll be back with more, I'm sure. Honestly, I'm surprised to see these complaints coming from people calling themselves liberals. It feels a little more like right wing talking points than issues liberals would have, and that's because they ARE right-wing talking points that didn't come from liberals. But hey...now you know a little more about insurance pools than you did yesterday, and tomorrow you'll know even more.

Office hours are 9-5. Post your complaints and questions here, and I'll do my best to debunk, answer or refer you to someone who can answer them.

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Comments

[Lawyer Mama]

Great post, Karoli! I also like to point out to young & healthy complainers that you never know if you'll be in a horrid car accident tomorrow. That's something we have no control over and it happens to good people every day. Since I once worked for a health insurance company, I know for a fact that a serious accident involving spinal injuries can make you run up against a million dollar policy limitation pretty damn quickly.

[Karoli]

Good point on the accident coverage. I've got a whole passel of other complaints when I re-open tomorrow. I'll include that scenario in the answers.

[Shawn Kelly]

Great as always, Karoli. I have tried and tried to explain risk pooling to some of my conservative friends, and they just don't get it. Sigh.

[Karoli]

Shawn, some truly see health care as something you either deserve, or you don't. Trying to explain risk pooling to them is a little like shoving an elephant through a padlocked door. You might penetrate but it won't stick.

[StephSchiff]

My point is usually that we pay for it one way or another. Why do you think costs are so high? It's not all greed - some of it is that we are paying for bill collectors and bankruptcies from those that chose not to get insurance or couldn't afford it and then couldn't pay for medical bills. How much are we going to save in the long run from not having to fund so many free clinics? What about doing away with a lot of the programs now that cover children that will now be insurable? Why is not one mentioning these cost savings?

We also have to look at the significant reduction in costs (and the length of time you have to wait) for Emergency Rooms. People won't have to use it as primary care anymore because they'll be able to go to a doctor. Many illnesses won't get to the point that they need an ER and/or hospitalization because they will be prevented or caught much earlier due to preventative care. People won't wait as long to seek help if they aren't choosing between a doctor or prescription and feeding their children.

[Alexis]

StephSchiff, Exactly! We already pay to provide care to the un/underinsured. The difference is now that money will provide basic, routine and preventative care to all so we don't all have to pay for someone with an easily treatable disease who was just unable to see a doctor for 20 years.

Great post Karoli, you perfectly highlight the flawed logic of so many of my peers. They all think that since they are young, healthy, single and employed that any reform requiring them to pay is a bad idea. Well, you all are only one emergency appendectomy away from wishing you had ponied up for better coverage. That I can promise!

Looking forward to next edition.

[Nicole]

And it is as simple as that. You can't have all the healthy people in one pool, and all the people with chronic conditions in another and expect to have affordable health care. At the end of the day, everyone ends up paying, one way or another.

As a Canadian, I don't get it. We pay somewhere in the vicinty of $1400/year in premiums for our family of three (and 75% of that is paid by my employer), plus we have two sets of private insurance offered by our two different employers who pay the premiums. But still, that $1400/year is that price because everyone in my province is in the same pool: young and old; healthy and infirm; singles and families.

As a side note, we have lifetime limitations on our private insurance; mine is $1M and I think his is $2M - but we don't run up against those limits very fast because all the big stuff is covered by the provincial plan.