I’ll let the legal experts sort out the arguments about the health care law before the U.S. Supreme Court this week. But what seems to be missing in all the discussion about the so-called individual mandate is the practical impact of the bill on the lives of everyday people and the complete lack of a Plan B if the court overturns part or all of the law.
For years I was covered by my employers’ health plans. They even took out my share of the premium so I never had to write a check. And the deductibles were small. Like most people on company or organization plans, I didn’t think much more about it.
And that’s the problem with our medical insurance system. If you have a job where your employer provides health insurance, you’re ok. But what happens when you lose a job or change jobs or your employer changes plans? And what happens with all those people who work for small businesses or who can’t afford coverage or who work part-time and the like?
I faced this reality a couple years ago when I set up my own business. For approximately $8,000 a year, I purchased a $7,000 annual deductible policy. That means that I spend $15,000 per year before my kids or I received any coverage (other than an annual physical). That’s pretty standard. A Health Savings Account mitigates some of the cost.
I almost was refused that policy because I had heart surgery several years ago to repair a defective valve and was forced temporarily to get high-risk insurance. I appealed and my doctors proved to the insurance company that I was in good shape and my heart worked fine.
So now I am extremely conscious of every medical bill. An ambulance ride for my daughter, injured in a basketball game, costs $1,800, and that’s without the siren. A dislocated finger I suffered coaching softball, pulled back in by an urgent care doctor, cost $800 (I appealed that one). An MRI for my daughter’s injured back cost $1,200 and so on.
Some would argue that it’s good that as a consumer I’m well aware of the cost of each medical procedure. But having such a high deductible policy makes you reluctant and overly cautious about seeking care unless it’s clearly an emergency.
But more important, I wonder what thousands of other people who simply can’t afford these premiums or these deductibles do. Most apparently don’t buy insurance. If they get really sick or injured, they go to the emergency room, where it costs five times as much to care for them. And the rest of us who pay for coverage pay more to cover them.
There are an estimated 50 million uninsured people in America, nearly 500,000 in Minnesota. That’s a big problem and it is an embarrassment in the richest country in the world.
By extending coverage to as many as 30 million uninsured, the health care bill tried to enlarge the insurance pool and spread the risk. It says insurance companies can no longer (beginning in 2014) refuse to cover someone with a pre-existing condition (like a repaired heart valve). It prohibits insurance companies from limiting your lifetime coverage. It says that you can keep your kids on your policy until they are 26. It provides for insurance exchanges in each state so if you don’t have a company plan, you can purchase a reasonably priced plan with reasonable benefits and, if you make under certain income, you can get a subsidy. It helps narrow the so-called donut hole for seniors’ drug coverage. It also begins to try to control costs.
The tradeoff for all these benefits and more is the so-called individual mandate. Each person is required to buy insurance or pay a relatively small fine.
That requirement is what has Republicans in Congress and on the presidential campaign trail so incensed. It’s an attack on our individual freedom, they say, conveniently forgetting that it was originally a Republican idea.
But look at it another way. If you cannot afford insurance or you have a pre-existing condition or your child has a pre-existing condition and you are refused insurance, isn’t that an attack on your freedom? A serious medical problem can ruin a middle-class or poor family. Is that not a greater loss of freedom than the requirement to purchase an insurance policy? After all, if you drive you have to have auto insurance. Why not health insurance?
As I listened to the Supreme Court Justices ask questions during the arguments this week, I wondered how much they thought about those millions of uninsured people or even insured people with medical problems who either can’t get adequate coverage or can’t afford it. After all, the justices have pretty good government health insurance policies.
And I wondered what the plan B is if the health care law is struck down. That’s not really the Justices’ job, but I haven’t heard much from opponents including the Republican presidential candidates on what they would do as an alternative to the health plan. Saying we should go back to the current system and tinker with it is not an option. We will remain the only industrialized country in the world including Western Europe, Japan, Israel, New Zealand, Australia and our neighbor Canada without some form of universal coverage. We will still be spending the most per person on health care with the 37th best health outcomes. And we will still have 50 million uninsured.

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