Health insurance. It's something you might not think you need, until you need it. Then you wish you had it. Or perhaps you want it but simply can't afford it. Either way, it's a critical necessity, despite what many people think to the contrary.
Confused over the ongoing fight over Obamacare? What to know exactly what the hell's going on and how it could possibly affect you? Then take a seat and read on as yours truly attempts to hash out an explanation. Keep in mind this explanation is rather simple and to the point, so there might be a few technical things and other nuances that got thrown out of the boat:
To better understand Obamacare and people's reactions to it across the political spectrum, it's important to understand how health insurance in works, not just in general, but in this country and elsewhere.
How the hell does this health insurance stuff work?
Health insurance is essentially a large group of recipients paying into a pool of money. When a recipient needs medical care, whether it's preventative care (monthly checkups, etc.) or emergency care, money is taken from the pool to pay for their expenses. Since health insurance works on the principle of there being more healthy people than sick, there's always a relatively large pool of money to tap into.
What's up with insurance companies and their coverages and why does the shit cost so much?
The vast majority of people in the United States rely on private health insurance providers. Here, most folks pay either a (steep) monthly or annual premium out of their own wallets or have a portion of their paycheck deducted to pay for a healthcare plan shared with their coworkers. As a result, there are thousands of different pools that people pay into for their coverage, some more expensive than others, all of them with their own rules and guidelines.
Private health insurance providers also have plenty of leeway regarding who gets to dip into the pool and who doesn't. On the face of it, you can't blame them - thousands of scattered insurance pools are more vulnerable to getting syphoned dry by people with a boatload of health risk factors. That means smokers, the morbidly obese, diabetics and others with a slew of health problems are either told to pay ridiculous amounts of money or get tossed out of the pool. Got a preexisting condition? Good luck. Insurance companies also have their profits to think of. These profits usually average around three percent, but that's been bumped up to around eight percent as of late, accompanied by rising premiums. Ordinary Joes and Janes who are the perfect image of health are forced to pay much more than they should, just to cover both profit margins and the folks who need to dip into the money pool.
And that dip's a relatively deep one, too. Thanks to the high cost of health insurance, approximately 48 million Americans, many of whom are on the wrong side of the poverty line, simply go without. That means they go without preventative care unless they're lucky enough to either pay for it out of pocket or land a job that gives them some form of coverage. A lack of preventative care means that potential health issues go undetected, usually for years at a time. In the end, most people won't go to the hospital until the proverbial shit hits the fan and they need a trip to the emergency room. Emergency room care costs big bucks. So does surgery and treatment for issues that could have been nipped in the bud early on (like, say, cancer). At any rate, the overall cost of healthcare skyrockets.
My health insurance provider told me to go fuck myself with a rusty pipe when I got sick. What's up with that?
Of course, insurance companies absolutely hate paying out hundreds of thousands of dollars to cover medical expenses, hence they'll find any excuse in the book (and a few that don't exist) to unceremoniously drop paying recipients if they dip too deep into the money pool too often. In fact, many companies have panels that review medical requests before signing off on them and those that don't meet their particular criteria are often denied. They'll also stiff hospitals on the bill, which is why they routinely charge insurance companies much more than necessary just in case they get shortchanged. The fight between hospitals, private insurers and their customers can easily be replicated by laying down in the middle of a pack of starving pitbulls with a bloody steak on your face.
Did you know that many private health insurance providers have a network of select hospitals their insured customers can only go to if they're to expect continuing coverage? Stray outside of that network and be prepared to take that second mortgage out on your soul.
So what's this single-payer shit I keep hearing about?
On the other hand, there's single-payer healthcare, commonly known as socialized or universal healthcare. With this type of coverage, there's one money pool (usually administered by a government agency) and every citizen in the country it's enacted in pays into that pool, usually through taxes or mandated fees. Except for the desperately poor, who are given a break and are still allowed to draw out of that pool. The all-inclusive nature of the single-payer system means that 1)there's only one huge pool to pay into and draw out of, therefore 2)there's always enough money in the pool to cover every paying recipient, plus those who aren't able to pay and 3)recipients wind up paying far less in premiums than they had to with private coverage.
Since it's the government footing the bill, hospitals and healthcare providers can rest easier knowing that they'll pay. And since it's the government's dime, the government itself can dictate exactly how much it's willing to pay said hospitals, thereby lowering overall costs.
In short, single-payer saves money. Instead of ignoring that stabbing, throbbing pain in the side for months until you get rushed to the emergency room for a $10k stay and a $100k emergency surgery, your single-payer coverage allows you to go to the doctor to see what that pain's all about. Thanks to that huge pool effectively subsidizing your doctor's visit, the $1k in preventative care costs you zero or damn near close to it.
Other, more respectable countries throughout the world have some form of universal health coverage, provided through public funding sourced from taxes and fees. Some countries combine their publicly funded healthcare with optional coverage from a private health insurer. Other countries leave their healthcare coverage up to these private companies, but strongly regulate how much they can charge and even provide significantly low-cost (or free) health insurance coverage. This is essentially the route that Obamacare's going (but more on that in a minute).
Wait...doesn't that sound an awful lot like Medicare/Medicaid?
It does, doesn't it? In fact, some would say that a single-payer system in America would just be Medicare for All.* As it stands, Medicare is strictly for those over age 65 or anyone with disabilities. Medicaid is for people who are too poor to purchase private coverage on their own - mainly families, women and children. Unfortunately, the eligibility requirements vary among each state. Each year, the federal government disburses a set amount of money to individual states for their Medicare and Medicaid programs. Some states are more generous with the proceeds than others.
Okay...Obamacare.
Once upon a time, President Barack Obama foolishly attempted to bring single-payer healthcare to these United States. The measure was dragged behind the Capitol by conservative legislators and unceremoniously double-tapped in the head. The End.
Said legislators dressed the corpse in a new suit, took out the stuff they didn't really like (like the whole single-payer thing), slapped on a sticker reading "private insurance-friendly" and reintroduced it as the Affordable Care Act, which Congress passed and the president eventually signed in March 2010.
The simplest explanation of "Obamacare" (which is what opponents called it whenever they wanted to disparage it - the name kinda stuck after a while) is that it's a stop-gap between private insurance and single-payer insurance. In other words, all of the private healthcare providers are now part of a regulated "exchange" where they are obligated to insure each and every citizen, regardless of their condition, at something approaching relatively sane premiums.
At the same time, each and every citizen is obligated (hence the term "individual mandate) to sign up for health insurance, so they won't get tempted to sign up for a quick, free dip into the money pool just at the moment they get sick and subsequently screw other paying customers. Those who don't sign up by March 31, 2014 get hit with a penalty, starting at $95 or 1 percent of your taxable income, whichever's greater.
So I lose $95/year if I don't sign up. Big whoop.
$95 or 1 percent of your taxable income. You make $70,000/year? That's $700 you have to pay. And it gets worse. By 2015, the penalty grows to $325 or 2 percent of your taxable income. The year after and subsequent years, its $695 or 2.5 percent of taxable income.
But Mack! I don't even have a pot to piss in, let alone a window. How am I gonna pay for this shit?
You don't. At least if your income's below a certain threshold. In addition to the individual mandate, the Affordable Care Act also expands Medicaid coverage to include individuals age 19 to 65. That means those stuck below the federal poverty line can simply opt for Medicaid coverage. That is, if their state's playing ball.
States highlighted in red aren't feeling the Medicaid expansion love.
Thanks to a U.S. Supreme Court ruling that mandated voluntary participation, 22 states have opted out or are leaning close to opting out of the federal government's Medicaid expansion through the ACA. That means if you make more than 100% of the federal poverty level, you can buy your health insurance coverage through the exchange for a significant discount. If not, you're left to the tender mercies of your state's income thresholds for Medicaid eligibility.
In the Great State of Alabama, the Medicaid income threshold for a family of three is $3,221. Per year. Make more than $3,221 but fall short of the $19,530 required to qualify for Obamacare? You're just about as screwed as the folks stuck in the Medicare Part D "doughnut hole".
Speaking of Medicare, the Affordable Care Act also unfucks a lot of what was wrong with it. For starters, enrollees get more preventative services (e.g. mammograms, colonoscopies, etc.) without paying extra. Enrollees stuck in the $2,970- $4,750 drug cost "doughnut hole" also receive a 50-percent discount when they purchase Part D-covered brand-name prescription drugs at the counter.
So why do guys like Ted Cruz treat Obamacare like the spawn of Satan and Grace Jones?
Because Tea Party?
But seriously, that's a good question that can only be answered with yet another lengthy and well thought-out blog post.
*Ba boom tish!
