I am that healthcare provider. I wrote a comment for an excellent story on health insurance by DarkSyde on today’s front page, but I thought the comment deserved wider circulation. I am reproducing it here and adding a few links. I have also added further comment and analysis, as my comment could be construed as too limited.
Healthcare is one of the most important issues of the primary season, and certainly will be in the general election, too. It is one of the main issues separating out Hillary Clinton from Bernie Sanders, and it deserves a lot more discussion than its getting here and in the mainstream press.
What I wrote:
As an actual health provider who is on insurance panels, I can tell you that much of the crap that used to go on still goes on under Obamacare. While access to insurance is greater, and the preexisting clause is gone, much is still problematic. Number one is that my clients often wait until their health (and I’m a mental health provider) has gotten really bad, because they have high deductibles under the plans they can afford of up to $3000. And this is after their insurance premiums. Now some of them have cheap premiums because they are subsidized. They are subsidized because they don’t have much money.
But Catch-22! They don’t have much money and get subsidized insurance, but the fact they don’t have much money means they don’t use the insurance unless things get really bad. Then they must pay out the money they can’t afford to begin with! The deductibles themselves are not subsidized. So what you have is a kind of bait and switch. The truth is health care is still not really affordable for many. What you do have with Obamacare is a kind of catastrophic insurance that puts a ceiling on health care costs. That is no small thing (for those who can afford Obamacare), but as a health policy, it’s pretty horrible.
I can tell you that some people are still losing their lives, marriages, and careers because of, for instance, depression (or PTSD, or psychosis, etc.) gone untreated, because of health care costs still way too high and discouraging people to get the care they need. Sadly, this is not some opinion I have. I have seen this first hand.
I’d add that many have had to switch doctors and medications with the switchover on health care plans, and that has caused serious problems in some cases as well. That would never happen with single-payer.
Bernie Sanders gets it. Hillary Clinton, in my opinion, does not.
Last November, Robert Pear at the New York Times wrote a good article describing the problems with the high deductibles and how they limit use of health benefits.
“The deductible, $3,000 a year, makes it impossible to actually go to the doctor,” said David R. Reines, 60, of Jefferson Township, N.J., a former hardware salesman with chronic knee pain. “We have insurance, but can’t afford to use it.”
In many states, more than half the plans offered for sale through HealthCare.gov, the federal online marketplace, have a deductible of $3,000 or more, a New York Times review has found. Those deductibles are causing concern among Democrats — and some Republican detractors of the health law, who once pushed high-deductible health plans in the belief that consumers would be more cost-conscious if they had more of a financial stake or skin in the game.
“We could not afford the deductible,” said Kevin Fanning, 59, who lives in North Texas, near Wichita Falls. “Basically I was paying for insurance I could not afford to use.”
Kevin Drum at Mother Jones responded to Pear’s article explaining that for only $50 more a month ($600 a year, at least in the state he looked at) one can reduce the deductible to $250. That sounds great, or kind of, since for the low income families eligible for this, who receive something called Cost Sharing Reduction (CSR), even the extra $600 a year is a lot to pay, as is the $250 deductible (per family individual).
But that’s only part of the problem. There are plenty of people — let’s call them the working marginal poor — who cannot get the CSR and then are stuck with a large deductible ($750) on the Silver plan that Drum looked at (which costs still $600 a year more than the Bronze plans with the $3000 or more deductible).
Yes, Drum is right. The Silver plan is a better buy… unless you are just getting by from paycheck to paycheck, like so many Americans, and then over $3000 a year before you even get any benefits paid out by the insurance company starts to look like a hell of a lot. According to CNN, 76% of Americans live paycheck to paycheck each month! What that means is that working class people put off using their benefits if they can, until things get really bad, and sometimes by then, it’s too late!
The Department of Health and Human Services addressed the deductibles scandal by reminding people (bold in original), “All Marketplace plans cover recommended preventive services without a deductible. Services like cancer screening, immunizations, and well-child visits will always be covered without having to pay your deductible, any co-pay, or other costs to you.”
I’ll let readers follow the links, or do research on their own, to make up their own minds. But I think it’s worth noting my own experience with the issue. For reasons of confidentiality, I cannot however describe actual cases. I’m afraid you’ll have to take my word for it. The issue of confidentiality keeps many doctors and therapists from more fully describing the stories of human tragedy they daily confront because of the terrible flaws in the health care system, even after the passage of the Affordable Care Act.
Hillary Clinton has herself said she is not content with what Obamacare has done thus far, and wants to make it better. Good for her! But meanwhile lives are at stake. It’s time to do what’s right and provide quality healthcare for all at no or minimal cost, to take the profit motive out of that business once and for all. The inequality in healthcare in this nation hits the working class/middle class and the poor harder than it does the well-off and the rich. Let’s change that now, and not wait another generation for incremental change that may never come.