One of the unintentional running themes in my blog has ended up being health care.
- In Albuquerque, John and Daryl were hit by a car. John refused to go to the hospital for treatment because of the cost.
- In Nicaragua, John sprained his thumb and needed to get it x-rayed to see if it was broken. We were very pleasantly surprised by the quality of care he received in the local hospital.
- In Panama, Davy had surgery to remove a particularly nasty ingrown toenail.
- In Colombia, he had his other big toe operated on for the same reason.
- In Ecuador, the poor kid went under the knife three different times – once by a drunk doctor.
- In Bolivia, Davy hit a patch of sand and tumbled down, pulling out his fingernail in the process. We got to know the local clinic there.
- In Argentina, I spent a week in the hospital with pneumonia.
Upon our return to the USA, our primary concern was what we would do about health care. Costs in the USA are out of control, and the cost for health insurance was outrageous. How does one put a dollar value on quality of life?
When John needed an emergency appendectomy, our decision was sorely tested.
In the end, we made the decision that having the opportunities for robotics and advanced math/science studies that we have in Boise made it worth dedicating 19% of our monthly income to health insurance. We also knew that even with the health insurance, medical costs would be too much for us to afford.
We crossed our fingers and toes, hoping beyond hope that we would not need medical care until we could get back to Mexico or some other country with affordable treatment options.
Now, the situation here in America has changed. In some ways, it’s a change for the better. In other ways, it’s a change for worse. It is, nevertheless, a change. For my readers from other countries who perhaps don’t understand it all, here is my account of how the Affordable Care Act (Obamacare) has affected us.
What does the Affordable Care Act do?
The health care situation in the United States of America was broken before. Seriously broken. The ACA attempted to fix some of the worst parts of our system.
1) Children are now allowed to stay on their parents’ plan until they are 26. Previously, kids would have been kicked off prior to that, leaving many with no health insurance at all.
2) Anybody with a pre-existing condition would be routinely denied coverage. Health insurance companies only wanted to cover healthy people who didn’t need care. If you were one of many millions with some sort of medical issue, insurance could (and did) boot you out. Now, the ACA has prevented that from happening.
3) There is now no lifetime max, meaning that you can continue to have insurance even if you have a condition that costs a lot. It used to be commonplace that people with serious illnesses would get treatment up to their max, then have no choice but to drop out of the treatment and die.
4) “Health insurance” has now been defined. Whereas before, you could pick up a plan that basically covered nothing, now there are set guidelines for what a health insurance plan must cover.
5) The maximum out-of-pocket expenses per year for a family is now $12,700. Previously, it wasn’t unheard of at all that people were paying $50,000 or more, depending on what happened with your family that year. One serious accident or illness could easily have led to a family losing their house and entire life savings.
6) Preventative care is now provided free of charge with every insurance plan. Too often, people didn’t get routine care due to the expense, which actually meant it was more expensive when the condition reached more advanced stages.
7) Health insurance companies are now required to spend a certain percentage of premiums on health care. That seems pretty obvious, but for years the companies have charged higher and higher rates, and pocketed the profit. Now, their profit level is stipulated by law. If they overcharge, they must issue refunds.
8) There are now subsidies available for people with low incomes in order to help them pay for the insurance premiums.
How the ACA affects us
So what does this mean for us? It means that we will be getting a much better plan for a much cheaper price. Although we do qualify for a small subsidy, even without it, better plans were priced about the same as our old plan.
For the first time since we arrived in the USA and decided to be self-employed, we will be able to go to a doctor without budgeting for it for months. Now, we won’t have to fly to another country if we need surgery done. And we’ll have the confidence of knowing that if we do need treatment, we won’t lose our entire life savings to pay for it. That’s huge.
How the ACA affects others
Unfortunately, some people are seeing their rates increase. I’m hearing from some people that their premiums are as much as doubling. I’ve heard from others that they have no choice but to go without health insurance now.
It seems to me that what we’ve done is manage to insure the poor, while at the same time, un-insure some of the middle class. We’ve traded one group for another. Which group has the greater number of people? I don’t know. I hope that when all the dust is settled, we will have more people covered with health insurance than we had before.
But what about health care costs?
What the ACA didn’t do is regulate health care costs at all. Although I suspect the reforms will affect costs somewhat, we still need to take some pretty serious measures to bring costs down. Yes, people are now insured, and that’s a good thing, but the costs are still entirely too high.
Why no public option? What about universal single-payer health care?
My theory on this is that the American people simply were not ready to move to a universal system. They were too tied to the idea of private health insurance companies and going from where we were to universal coverage was a leap way too big. I’ve had a few people try to explain why they were against it, but so far I’ve never heard a logical argument against.
The propaganda is deep here in the USA these days. Opponents of the ACA talk about death panels and government mandates of certain procedures. They claim Obamacare is killing jobs and that socialized medicine equals communism. Mostly what they say is flat-out false, yet there are many who believe it.
I was discussing the idea of living your dream with some friends the other day. For every single American in the group, our major concern was getting sick and not having enough money to pay for treatment. Even with health insurance, we’re concerned about the financial side of health care and that affects what we’re willing to do in terms of living our lives the way we want. We Americans all had back-up plans to go live in another country if the worst happened.
For my Canadian and British friends, however, they had the comfort of knowing that if something major happened, all they had to do was get back home and they would be taken care of. They didn’t have to worry about saving many thousands of dollars for a medical emergency. They didn’t have to think of a back-up plan of living in some other country if they get really ill.
To me, that speaks pretty dramatically about our health care problems in America.
The Affordable Care Act has attempted to fix some of the problems, but we still have a long way to go.