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Tuesday, October 1, 2013

'ACA' or 'Caca'..?

I couldn't find a picture of an insurance broker.

Hello, darlings. If you’ve been online, or had the TV or radio on this morning, seems like everyone is talking about two things – the government shutdown, and the Affordable Care Act. Of course, the two are inextricably linked, as of this moment. And I find myself in an incredibly uncomfortable position. I have to tell you something that will very likely prove very unpopular, and may surprise you:

I am a Democrat who HATES and DESPISES the ‘Affordable Care Act’.

I’m trying to act like a grown-up and refrain from calling it ‘Obamacare’ because, as the staunch supporter of Human Rights that I am, as well as a die-hard, extremely vocal LGBTQ advocate, I am also a Democrat. I support President Obama, and agree with nearly all of his policies. The ACA, however, I just can NOT get behind. And I can’t even pretend to like it in order to avoid embarrassment or ostracism by my friends. It stinks to high heaven, and I’ll tell you why.

Let me start with the things I do like about the ACA. (Yes, there actually are some.)

1. It will allow people who currently cannot get health insurance to get coverage. This will save lives, and is obviously a Very Good Thing(tm).

2. … ::crickets chirping::

Well, that’s the only thing I like about it, actually. Clearly, saving lives has to be seen as a positive no matter how you look at it, so I can’t really argue against that particular facet of things. Saving lives, yay!

But Unicorn, I imagine you asking, little foreheads wrinkled in concentration and dismay. What about the ACA could you possibly object to? Why do you hate America? Darlings, what I object to about the ACA is very, very simple: It’s a stinking, steaming pile of crap that has been served up to the people of this country disguised as a Death by Chocolate. And most people do not understand why.

(So let me help.)

No one, including yours truly, can argue that there is not a VERY, very serious problem in this country with healthcare. Many people are uninsured, and can’t get the care that they need just to continue living, let alone to fix or improve their health enough to enjoy what most would consider a reasonable quality of life.

(I sincerely hope that none of you got as far as the phrase ‘continue living’ above and stopped reading! Hang with me. I promise you there will be NO idiotic ‘death panel’ remarks here. That is SO not the direction that this is going.)

Individual health care plans are very expensive, if they accept you, and many exclude preexisting conditions. Even with insurance, you’re not out of the woods: people are often saddled with huge bills for amounts that the insurance doesn’t pick up, amounts they consider to be ‘above what is reasonable’ for the cost of the procedure, medication, and so on. Healthcare is freaking expensive, and the doctors, hospitals, pharmaceutical companies, and other providers will charge whatever the market will bear.

(Please remember that last bit in particular – we’ll come back to it shortly.)

In a ‘first world’ country like this one, no one should have to go without care, or go into debt in order to pay for necessary care, in order to live and to have a decent quality of life. No one. Let me be very clear on that.

But Unicorn, that’s why we have the ACA! That’s the magic bullet that will fix all of our healthcare woes! Now everyone can get insurance!!  Right? Well, yes and no. And by that I mean, ‘mostly a resounding and hearty ‘how can we be so goddamn blind and/or willfully stupid in this country??!!??’   

::ahem::  Sorry. I guess I feel a little bit strongly about this. Please allow me to continue in a calmer tone. ::deep breath::

The ACA is designed to solve one tiny part of the problem: the insurance part. The government somehow managed to convince the otherwise-intelligent (for the most part) citizens of this country that this somehow magically erased all the rest.

What rest? Oh, come on now, you remember – the part where health care itself is a huge money-making industry in this country. And when you’re looking for the root causes motivating anything, particularly when the government is involved, the rule is – always – follow the money.

I’m going to force myself to resist the temptation (though it is very strong) to use this particular post as a platform for my personal beliefs about whether or not the medical industry (aka Big Medicine) cares more about making money than it does saving people’s lives. That’s a blog for another day. But for today, let’s look at asking ourselves the really important question about what should be the elephant in our living rooms: Why is the ACA going to make the real problem worse, instead of better?

Short answer: Money. (See above)

Long answer: Because by offering the American people a band-aid to stick over the hemorrhaging wound where our asses used to be (aka the ACA), the government gets to pretend that they did something. That they helped. And they did – a little bit.  Those people who desperately needed healthcare and could not get insurance (and therefore could not afford said healthcare) will now be able to get insurance. Which, as I mentioned earlier, is a Very Good Thing(tm).

But follow the money.

The real problem, the cost of the actual care itself, has not been addressed. The cost of healthcare – even under the ACA – has not changed.

Under the ACA, all people will have health insurance (or pay a hefty penalty). The cost of that insurance will be subsidized – for some. This, to many people, is another rallying point – but it doesn’t seem to work the way we thought it would.

In a specific example, my partner is currently not working. I pay for an individual health insurance plan that covers my partner – which costs a lot. It’s a decent plan, and I haven’t minded paying for it, since I was working myself at the time. I don’t have health insurance right now myself, because I mostly do contract work, and I couldn’t afford to pay for two individual health insurance plans. We just got a letter from my partner’s insurance company saying that if we keep that plan, the cost of the premium is going up – substantially - after October 1st, due to the start-up of the ACA. (Thanks, guys.)  So, no worries, my partner will switch to one of the new subsidized ACA plans, right?

Wrong. Even though my partner doesn’t work, and hasn’t worked for over a year, because my partner lives with me, no subsidy. Zero. And it’s not because we’re “partners” – it’s the same for anyone who lives in a household with any working adult who earns more than the Medicaid threshold, even if the other people in the household are in no way responsible for that person’s bills. Proximity = responsibility, apparently. Oh, and to make things more interesting, this is still the case for my partner and myself, even though I’ve been out of work myself for the past two months.

You heard me correctly: Even though neither of us is working, we do not qualify for any assistance with the insurance premium costs under the ACA, per the guidelines on the website. Why, you may ask? Because we are not homeless.

Since we have a house to live in, that counts as an ‘asset’ that we have, the value of which is counted against our ‘Medicaid threshold’ amount (or whatever the hell they call it). Plus, I also own a Chevy Cobalt (well, mostly - the bank owns some of it), and my partner has a beat-up old truck, so now we’re waaaaaaaaaaaaaaaaay out of consideration. It seems like the government feels that we should sell our house and cars, thereby eliminating both our shelter and our ability to get to work should we (hopefully) find a job, in order to quality for government assistance in paying for those ‘affordable’ health insurance premiums that they are requiring us by law to purchase - or to pay the fine for not doing so.

Let me address that briefly, also, as there seems to be a lot of confusion going around about that penalty, also. I’ve heard people saying, “Quit your bitching. Don’t buy the insurance if you don’t want it. The fee isn’t that high.” According to the IRS, “For the first year, the charge for not obtaining health insurance is $95 or 1 percent of household income. The penalty will increase, though, to $695 per person or 2.5 percent of household income in 2016 and then according to a cost-of-living formula for following years.” That last phrase sounds a bit like weasel-words meaning they reserve the right to decide how high to hike the fees after 2016, depending on how many people are opting out of buying into the insurance pools – but that’s neither here nor there right now. Even with the stated fees for 2016, you could be paying $695 per person in your household, or 2.5% of total household income, whichever is HIGHER – plus in addition paying the cost of any medical bills you accrue. Anyone who claims that’s not a punishment is lying, either to you or to themselves.

But, darlings, that isn’t really my point.

The crux of this whole issue, is that the ACA is not in any way that I’ve seen so far addressing the actual, real cause of the health care crisis in the United States: the bottom-line, dollar costs that people are charged to receive medical care and/or drugs. Remember that, from way up at the start of this post?

We in this country do not have an ‘insurance problem’. We have a ‘cost of medical care problem’. 

The government, in the pocket of Big Medicine and Big Pharma, managed to pull a very clever bit of sleight-of-hand over on the American people. They’ve got us all up in arms over whether or not they can force people to purchase a product that no one needs, to solve a problem that they artificially created, and are calling it a miracle cure. This is Snake Oil, only now we’re calling it ‘insurance’, and the very real problem of people being charged extortionate and obscene prices to receive treatment and/or medication has – whoosh! – somehow disappeared.

Where did it go? Check behind the curtain. But instead of Oz the Great and Terrible, you’ll find members of Congress, holding hands with Big Medicine and Big Pharma, and laughing all the way to the bank.

With the ACA and the ‘individual mandate’, Big Medicine and Big Pharma win. Game over, we lose. The providers can and will continue to charge ‘whatever the market will bear’.

Did you ever notice that most providers, including drug companies, will actually charge you less if you tell them you are uninsured and are paying on your own? Did you ever pause to ask yourself why?  It’s because they are fully aware that they can charge the insurance companies more.

So, now that we will ALL have insurance under the ACA, there is literally ZERO incentive for the providers and the pharmaceutical producers to lower costs – because they can charge the insurance companies more than they would an individual who was self-paying. And please keep in mind the ‘reasonable limitations’ that the insurance companies use – they will only pay so much, and then who pays the rest? Oh, wait – we do! We, the little guys, receive a bill in the mail later stating that we owe X-amount of money that the provider charged and that the insurance will not pay. Why did they charge so much? Oh, right. Because they can. So sorry.

Let’s review: We pay money to the insurance companies under the ACA to obtain insurance. Some people will be lucky enough to receive subsidies – many more will not. (Insurance companies win!) The providers charge their usual outrageous fees. (Providers win!) Insurance pays some of that. Then we get a bill for the amount over ‘reasonable and acceptable’ (which is a significant amount). (We lose!) What is wrong with this picture?

EVERYTHING. Let’s stop throwing time and money at a smoke-screen issue designed specifically to put more money into the pockets of Big Medicine, Big Pharma, and Big Insurance (where it funnels back into Big Government’s pockets, of course). Follow the money, remember?

Until we as a country face the reality that medical costs have to come down, nothing will change. The rich (individuals and corporate conglomerates alike) will get richer, and the underlying health care problem will not change.

The reality we are not supposed to discuss is so very simple: If medical care were made affordable, there would be no need for health insurance.

Why the focus on insurance?

Why the reluctance to tackle actual health care reform?
Money – and self-protection.

Members of Congress, whose job is supposed to be to protect their citizens’ best interests, are more concerned with their political popularity than with actually doing what would make sense or solve the problem. If the costs of healthcare were regulated to the point where citizens could afford to pay for their own care – without insurance – Big Pharma, Big Medicine and Big Insurance would lose money … and goodness knows we couldn’t allow that.  

The ACA is an ill-conceived way of pretending to solve a very real problem by creating a new problem to distract from the truth. Insurance isn't the problem. 

Unless health care costs are made affordable, we will continue to waste millions of dollars, and bankrupt our own families trying to afford what should be a basic human right: the right to affordable medical care.

Helping those who can't get insurance will save lives - but it should not be the only step we take to try to fix the real problem. How many more lives would we save if people could actually afford to go to the doctor or receive medication without paying hundreds (or thousands) of dollars into the pockets of an insurance company every year - money that could be spent on care instead of insurance, in a world that made sense.

Instead, we’re cheerfully digging ourselves deeper into debt, confirming the rights of the Big Medicine providers to charge as much as they please just to line their pockets, and acting as if someone hasn’t just handed us a gigantic shit sandwich.

The ACA is caca. Spit it out!

Demand real healthcare reform and real change.

Stand up. Speak out.

Not nearly as tasty as it looks.

P.S. I very much welcome discussion and sharing of your opinions on this issue. I know it's a very volatile one. Let's talk about alternatives to the ACA, things which would actually make sense and solve problems, rather than lining the pockets of insurance companies or BigMed. Please join in the babble! 


  1. For the record, I fully agree. The ACA is a bandaid over a gaping wound. It solves a small number of problems in an inherently broken system which was designed to be exactly that -- broken. When the bill is self-described as "the less medical care we give them, the more money we make," it should come as no surprise that the resulting system is set up like a casino -- you may see short term wins, but ultimately the house always wins and those wins are intended to keep you hooked, sinking in money and blind to the fact that you're losing your shirt.

    The ACA is a good thing in that it gets people insured who otherwise have no hope of being insured. It's a good thing in that it forces insurance companies to spend a larger chunk of their income on payouts. It is a bad thing in that it ties us to a system which should not exist. We should have what everyone else has -- a single-payer plan. But we don't and probably never will, because someone somehow managed to reconcile Ayn Rand and Christianity and now Jesus Christ apparently wants us to spit on the sick and dying and poor and broken and miserable and used up and discarded. "HE WHO DOES NOT WORK SHALL NOT EAT," thunders the billionaire from the pulpit, and the congregation nods and roars approval.

    And the Antichrist reigns.

    1. Great comment. Thank you for joining the babble! Let's hope it doesn't get to that point. We're not quite there - yet. ;)


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Please be kind to each other - I welcome discussion and conversation, but if you're deliberately nasty to someone, that makes kittens cry. Let's keep it fabulous!

~ The Unicorn