Monday, December 22, 2014

Don't leave the ACA out of Xmas

Sorry, it's been a while.  Work, work, work.  But I have been arguing with a friend of mine (both of us are members of Labor for Single-Payer, but he's more active in it), and here's my latest spew:

First let me say I do think the ACA is "woefully inadequate."  Single payer is what we need, or nationalized health care, but some business interests (and not others, interestingly enough) and their lapdog politicians have blocked anything close to that (along with much that is not even close).  And since we failed to get either of those things, it would have been nice for elected representatives (especially Democrats) to at least include what was called "the public option" at the time.  I don't think any of those things would have necessarily solved the problem this poor guy [see below] is bringing up, but I'll get back to that.  I still have to say the ACA helped millions of people get coverage, and that is nothing to sneeze at.

OK, this guy [below] is a perfect example of what's wrong with the US health care system, 'then and now'.  It's a maze of nonsense and penny pinching that is not set up to help people (as "health care" might imply if logic mattered) but to do as much as people can pay for or win by Machiavellian realpolitik.  This guy is dying of cancer, and there is treatment that will keep him alive, but our system requires that he play a game to get it.  Of course there are many, many people working in the system who care, but they are not in control.  Even a man, like this guy, who has had a decent union job for years with health care gets screwed; COBRA was an improvement in 1985, but you still have to pay for it, etc.; and then along comes the ACA and the guy still gets screwed.

But that's the first point: he's screwed with or without the ACA.  A lot of people are helped by the law; a lot of people are not.  But let's be clear on what the ACA caused and what it just didn't help with.  Big difference. The ACA is not screwing this guy any more than COBRA screwed him, or Medicare screws him by not including his age group, or Medicaid screws him by not covering him (although you could make an argument his state is screwing him if it refused to participate in the Medicaid expansion under the ACA).  I think you could make an argument that the Obama Administration/Congress screwed him by not instituting a much bigger economic stimulus (after all, when business slows down and businesses start laying people off, and the response of federal, state and local governments is to slow down its business, too, and lay off more people, there is no conceivable way that is going to help) -- and certainly the austerity pushers screwed him.

So the second point has to be that, yes, the problem with the health care part of this picture is that in our system our health care is too tied to work, and even with the ACA it's just byzantine.  Single payer would fix that.  It just would.  There would be no more getting bounced from insurance at work to COBRA, in and out of work and the exchange.  Because under single payer there is only one payer.  So I agree that this story and the article make a good case that this is true (if this anonymous person is real).

But here's the third point: single payer or even national health care might not help this guy.  Look at what happened to his treatment plan.  His new insurance didn't cover his medication.  He says he didn't have a 'Cadillac plan' (an offensive term, BTW, for real health care) but he got the care he needed.  Millions of people in the US with health insurance have experienced this denial of coverage.  In fact, the ACA fixed some of it by making it illegal to turn someone down for 'pre-existing conditions' -- which was one of the minions of evil facing all of us before the ACA and the reason millions of people could not change jobs even in good times without risk of death.  Regulation (ACA) fixed that.  And regulation could fix the problem this guy experienced by setting up a system that required coverage in certain circumstances (not all -- providers already milk it when they see you have good health insurance;  over-prescribing is real, and over-testing is 'not just a village in the Alps').  Of course we do not know the circumstances [below].  I remember when my stepfather had colon cancer and then liver cancer.  Even with excellent health insurance, he was not a good candidate for, for example, transplant, for reasons that had nothing to do with money (people are superstitious or lazy about donating their organs, so there just aren't enough, and with aggressive cancers the benefit is highly questionable anyway). 

But assuming that it was just that his plan was inadequate -- and, remember, there are different plans on the exchanges under the ACA; buy a cheaper plan, get cheaper coverage (back to the bigger problem of money) -- but even 'Cadillac' plans with move prescriptions and other treatments from one tier to another, or just drop coverage for certain things, even though you have a signed contract with them (the contract usually says they can do this, so take it or leave it).  But regulations require coverage for certain treatments and could require others, if we want to pay for it (hopefully by some progressive means, i.e. taxing the rich, but this is by no means given).

So this is point 3b, I guess.  I'm saying even under single payer this could happen, if whoever administers the plan decides some treatments, or some cases such as returning, metastasizing cancer, won't be treated, or won't be a priority.  The right-wing calls it 'rationing,' but of course we have rationing now - just on a different basis, profit instead of scarce resources.  My point is not about problems with single payer, or national health care.  We can cross that bridge IF we ever get there.  And whatever problems come with it would be well worth it.  They ARE worth it in countries where they have such things.  My point just that if we would still need regulation to ensure this guy gets coverage even under single payer or national health, and we can work for that now, with ACA.

In other words it doesn't have to be all or nothing.  I'm glad it doesn't, because I worry we may never get single payer or national health.  I hope I'm wrong.  But regulations on what has to be covered could help people now, rather than waiting out the next Republican or Blue Dog president.  Hillary Clinton, for example, would not touch single payer, but she might push for legislation to improve the ACA.  I'm just saying.  With enough pressure even a Republican might.

But get ready for more crying about the cost of health insurance going up.  We cannot, and I believe we can never in any of our lifetimes, escape the problem of progressive taxation.  Everything we want to do demands it.  Nothing we need will work for long without it.

Again, just saying.

~ END ~

Here's what I'm responding to:

The Obama administration's "health care reform" is woefully inadequate. Elected union officials and elected government officials who claim that the ACA is working well will lose all credibility. We should not have to choose between the dishonest defense of the ACA on one side and the across-the-board attack on health benefits on the other.

One Trade Unionist's Horrific Experience Under the Affordable Care Act (ACA)
When the President first proposed the "health care reform" that is today known as the Patient Protection and Affordable Care Act (ACA), he famously said, "The good news is, if you like your health insurance you get to keep it." What he should have said was, "If your boss likes your health insurance, you're stuck with it." He could have added that if a mean-spirited Republican governor got to block good health insurance options, you would really be stuck.

 What follows is a true story of one worker's experience with "affordable care." He is a member of the New Jersey State Industrial Union Council and an activist with the Labor Fightback Network. His experience illustrates the problems with so-called "Obamacare" and shows why working people need a single-payer health plan.

When I got my journeyman's card in the International Typographical Union in 1978, I had health insurance coverage that would be the envy of any working person today, and I got it on Day One. It covered everything, and I didn't have to pay a dime for it, unless the employer contribution under our contract failed to meet the premium increases (and it often happened) in the last year of the contract. The Scale Committee always managed to get the employer's contribution to the Welfare Plan increased in the new contracts to cover the previous increases
and even back then the cost of health insurance was rising much faster than inflation, which was running rampant at that time. When we did have to cover the shortfall in the Welfare contributions, it was a few dollars a week, nothing like the payroll deductions that most workers have to pay now.

In 1992 the shop closed, and I was unable to get another union job in the trade. For the rest of my working life, I had to cope with health insurance plans, including Health Maintenance Organizations (HMOs), with high deductibles, high copays, and a long list of procedures and medications that were not covered. And of course, there was a hefty deduction from my paycheck to pay for it. As inadequate as it was, I was glad to have it when I was diagnosed with prostate cancer in 2001. I was able to get treatment and remained cancer-free for eleven years thereafter.

As working people's living standards steadily declined through the Reagan, Bush, Clinton, and son-of-Bush administrations, I gradually gave up on the idea that I would ever be able to retire, and I was reconciled to remaining on the job until St. Peter tapped me on the shoulder and said, "It's time."

That changed in November of 2010, when my boss informed me that he had to "reduce payroll" and that I was being terminated "effective immediately." I was given two months' pay as severance and a bill to continue my health insurance under the COBRA plan
$1,400 a month, to cover me, my wife, and my daughter. Here's the thing: this was no "Cadillac" health insurance plan! It was barely adequate, and in many ways inadequate, but adequate or no, $1,400/month was a budget buster. If I attempted to keep the health insurance up, my family would be destitute within six months. My family and I became uninsured.

As bad as private health insurance often is, I don't recommend being uninsured, especially if you're at the age where health problems start showing up more often. In the early spring of 2012, my doctor informed me that my prostate-specific antigen blood test (PSA) had gone from 0.2 to 7.0
higher than it had been when I had cancer the first time. I saw a specialist, who confirmed: the cancer was back. Recurrent prostate cancer cannot be cured; it can only be managed. The usual treatment is an injectable drug to suppress the hormone testosterone, which causes the malignancy to grow. It is administered every three months, and it is very expensive.

Prostate cancer generally is not life-threatening, but left untreated it will metastasize. That's when it kills
when it gets into the bones, the pancreas, or travels up the bloodstream to the brain. So it's important to keep it from growing and metastasizing. At first, I tried holding it back with dietincluding going to a completely vegan dietand immune-building supplements. The PSA kept rising for about a year, and here I was uninsured facing massive expenses to stay alive. Fortunately, the doctor and I came to an arrangement: he offered treatment to me at his cost, and I managed to "fund-raise" the money from sources within the family. We'll revisit this issue.
That summer I was in Newark, NJ, on a 97° day and got heat stroke. A friendI should say a life-saving friendcalled the ambulance and I was transported a few blocks away to University Hospital. I was there from late afternoon until past 2 a.m. In those hours I ran up medical bills exceeding $8,000. It took nearly eight months to straighten the mess up. I managed to get the bill reduced considerably, but I will still be paying it off for years to come, for perhaps the rest of my life.

Then in December I had another fainting spell: two days after Thanksgiving I collapsed in my bathroom and had to be taken by ambulance to the nearby hospital where my personal doctor had attending privileges. I spent two-and-a-half days there, running up thousands more dollars in medical bills. Again, I negotiated them down, but I will be paying indefinitely.

No, I don't recommend going without health insurance.

I am not yet old enough to be eligible for Medicare, so when enrollment opened under the ACA,  I did as I was told and tried to enroll. What an ordeal! First I tried the website. I would enter my information, and the website would change it. Then I attempted to edit the information, and the website threw all of it out and made me start again at the beginning. It changed the information I had entered in the same way the second time! Finally, I called the enrollment phone number and asked if I could submit my enrollment anyway. I was told that I could, but when my reply came back, the spaces where it was supposed to tell me how much of a subsidy I could get were blank! I called the phone number. The first time I called I was told that I didn't qualify for any subsidy at all as a long-term unemployed person over the age of 60, who has cancer! I called again and was told to apply for Medicaid. I tried that and found that I did not qualify for Medicaid. This runaround went on for weeks.

Of course, I was not the only American coping with this non-functioning website. It soon became a national scandal, ultimately costing Health and Human Services Secretary Kathleen Sebelius her job.

After two months, the ACA website was revamped. I threw out my original enrollment and attempted to re-enroll from square one. This time I was given a subsidy that seemed in line with my income, and I proceeded to enroll in a health insurance plan that cost $285 per month to cover my wife and me.
The policy reminds me of nothing so much as the health insurance I had when I was workingoverpriced and inadequate. The deductible is enormous, and the copays are not much different than paying the full bill at the doctor's office. However, I can't afford another hospitalization without insurance, and the regular testing that every cancer patient needs to have becomes cost-prohibitive without health insurance. Of course, like so many others, I'm scratching my head and asking, "So this is health care reform?" However, I was quite surprised by what I was to find out next.
When I became insured, the specialist treating my cancer wrote a prescription for the testosterone-suppressant and asked me to fill it at the local pharmacy. His nurse would still administer the injection, but I would supply the medication, and my insurance would pay for it-supposedly. I was astonished when the local pharmacist informed me that my insurance did not cover the medication that is quite literally keeping me alive, and that to fill the prescription it would cost me over $3,000 per dose, which, by the way, is a 500% markup (according to my doctor). I am still reeling from this shock. The good news is that my doctor is willing to continue the same arrangement we had when I was uninsured.
Is this what the Obama administration considers "health care reform"? Is this the best that can be done in the United States of America? So many countries which are less rich and less powerful than this one have single-payer health care systems that provide care for every citizen. Even after enacting the ACA, our health care system is a national disgrace.
The inadequacies of the so-called "Affordable Care Act" have handed the labor-hating politicians of the far right a golden opportunity in the upcoming elections. Working people, including rank-and-file trade unionists, can see that the Obama administration's "health care reform" is woefully inadequate. Elected union officials and elected government officials who claim that the ACA is working well will lose all credibility. We should not have to choose between the dishonest defense of the ACA on one side and the across-the-board attack on health benefits on the other. The time for the organized labor movement to rejoin the campaign for a single-payer health care system, starting with Medicare for AllHR676, sponsored by John Conyers of Michigan, and S1782, sponsored by Bernie Sanders of Vermontis now.
Issued by the Labor Fightback Network. For more information, please call 973-944-8975 or email or write Labor Fightback Network, P.O. Box 187, Flanders, NJ  07836 or visit our website at Facebook link :
Donations to help fund the Labor Fightback Network based on its program of solidarity and labor-community unity are necessary for our work to continue and will be much appreciated. Please make checks payable to Labor Fightback Network and mail to the above P.O. Box or you can make a contribution online. Thanks!

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