The Mandate

Continued from Anna’s Story.

Fortunately, Anna didn’t need a payment plan.  Her sinus infection responded to the antibiotics and she recovered.  Eventually she found a job with more money and health insurance, and was able to move into a house with heat and hot water.  Anna’s story is no fairy tale, but if it were, it would end “and they lived happily ever after.”

Before you read further, here’s a heads-up.  It’s been a while since I wrote anything about access to healthcare.  I promised to post an ostrich alert any time I do, so that those who don’t want to read about the politics of universal coverage would have fair warning.

The American College of Physicians website includes a blog by Dr. Bob Doherty, and a recent post there, Confusion rules the day, discusses the possible unintended consequences of the recent ruling in Florida about the constitutionality of the Patient Protection and Affordable Care Act (PPACA).  Dr. Doherty closes his post with a question for those who oppose the individual mandate, and asks, without a mandate, how society can get insurance for all.  I responded in the comments section, but another person’s response reminded me of Anna’s story.

The individual mandate would not have helped Anna.  One must have money in order to spend it – a simple economic fact that politicians don’t seem to grasp.  Mandate or no, Anna could not have purchased insurance. 

A mandate is/was unnecessary because Anna did not need insurance.  She needed a doctor.  Think about it; when we send aid to third-world countries, we don’t send boatloads of insurance policies.  We send medicine.  We sponsor doctors and nurses to go work in their professional capacity.  How futile it would be to ship insurance plans to sick people!

Instead of a mandate, our nation needs medical care to be available and affordable.  The mandate does not make medical care available to people.  The mandate does not make medical care affordable.  It just adds expensive layers of bureaucracy to something that doesn’t need to be that complicated.

Insurance does not equal access to medical care.  Every January, my family physician’s office (and likely many more throughout the country) has a sign near the reception desk saying, “We no longer have a contract with xxx insurance company.”  If an insurer won’t pay a reasonable fee, doctors won’t accept that insurance, hence the policy is worthless.  Consider difficulty that seniors have in finding a doctor willing to accept Medicare.  Insurance as we know it now is not the solution.

I’m puzzled as to why the focus is how do we give everyone health insurance?  A more appropriate starting point would be how do we make it possible for patients to see a doctor and get treatment when they need it?  We need to give people better access to medical care without the burden of insurance that costs more than a house payment.


13 thoughts on “The Mandate

  1. Pingback: Anna’s Story « ∞ itis

  2. I don’t disagree with most of what you said. However, take Anna. Drop her into your shoes, but with no better, or not much better of a job, or a husband. Where it wasn’t a simple sinus infection requiring one-time treatment. Where she needed x-rays, MRI’s, PT, DMARDs, then biologicals. Or had cancer. Or MS. Could she really work out a payment system for those? Could she keep working at her job without those treatments so she could keep up the payments? She’s got nothing else to barter with.

    Unless you want to go to a single payer system, there is no way the current system can get rid of INSURANCE COMPANIES without every single related medical provider and medical business entity cutting their charges severely which I don’t see them being willing to do. As right as some of your assumptions seem, I don’t see them truly working out that way BECAUSE we are so entrenched in our capatalistic medical ‘SYSTEM’ already. It would require some kind of catastrophic CRASH and reboot. Is there a way to re-build this wheel that won’t bring our economy to a grinding halt? Do you really see ALL the players being willing to give up whatever it will take to actually get a true and pure market-based system of complete medical care off the ground?

    • Under the current system, Anna can’t afford a doctor or meds or surgery or expensive tests. She’s SOL. Telling her that she is obligated by law to buy health insurance (the mandate) doesn’t magically give her insurance – she doesn’t have money to buy it. She can’t buy insurance without money. The mandate doesn’t help.

      I’m not saying that insurance doesn’t help. It’s the mandate that doesn’t help.

      If doctors didn’t have to employ coders and billers and people to act as insurance liaison, they would be able to lower their fees. Whether they would, I don’t know. Would ALL players come to the table to find a workable solution? I doubt it.

  3. Have you ever looked into the Canadian medical system? I’m not exactly an expert on the subject, but what I know is this:

    We get a free Medicare card from our province, and that means we can use that when we visit the doctor. Seniors have assistance with the cost of prescriptions. If you need to see a specialist, you can either make an appointment on your own and pay for it, or go through the referral process which takes a few months more.

    We also have health insurance plans – you can buy them yourself, but mostly they come with jobs as benefits. So it’s more of a two tier system, but it works.

    I don’t really understand how the system got so screwy in the states. I do know that when you compare the two countries, the states tend to be more conservative = more opposed to paying more taxes to support social programs, so that may have something to do with it.


    • Nobody’s understands how we got the system we have. It’s nuts.

      We have a country that was founded largely by people who wanted the government to butt out of their private lives. People were proud to be “free and independent” and were willing to work hard to get the things they wanted. Now we have a huge number of people who think it’s the government’s job to take care of everybody. Taxpayers are opposed to paying even more taxes for welfare programs because we see the lifestyle choices of people on the welfare rolls.

      I don’t know the details of Canada’s medical system. Living in Washington, I see Canadians coming here and paying cash for medical treatment because they can’t get what they need in a timely manner at home.

      I have no problem making free care available for everyone, eliminating the huge hassle currently involved in applying for government assistance. However, it needs to just provide the basics of what people need (according to their doctors, not according to politicians). By way of analogy, there’s no reason to give away cadilacs; we can just hand out bicycles.

      Thanks for commenting.

  4. Of course if all of White Coat’s predictions come true based on stories he posts on his site, actual access and services for the increased medicaid eligible recipients will still portend dire situations for some.

  5. And of course, you still have to be able to afford the copays, coinsurance and your share of any bills, even if your insurance premiums are fully subsidized, which of course would be hard for someone like Anna if she has RA or other serious chronic conditions.

  6. I haven’t forgotten about the subsidies. It’s possible to offer subsidies without mandating coverage.

    My family’s costs are already high. After I stop at the pharmacy later, we’ll have paid over $1400 out-of-pocket so far this year. My husband postponed a root canal & crown, or it would be even higher. Two appointments later this week will add another $400(ish). That’s in addition to our $1200 monthly insurance premium (which the IRS does not allow the company to pay for us).

    The whole point of PPACA is to move our country to government-paid health care. I’d like to see the president and congress subjected to whatever plan the rest of the country has; that would make them more careful about the details of the plan.

  7. I guess it wouldn’t hurt to define/differentiate “welfare programs”. I know there is a lot of waste and fraud in many of the programs, but some are truly needy of it. The one person I’m aware of in that situation gets less than seven hundred a month total to live off of. No cadillacs there. But was not able to work long enough to pay more into the system, so can’t get more out of the system.

    • 🙂 Agreed, there are different programs and different situations.

      If a kid drops out of school to have a baby, she can live off welfare for a long long time. OR she can have college classes paid for so that she’s qualified to get a job to support herself and her family. I’m happy to have my taxes help in this situation so that she can get on her feet and become part of the workforce paying taxes. Not so happy to pay for a second, third… child on people who won’t make an effort to improve their situation.

      I am not happy to have my taxes supporting people who just won’t support themselves. We had a neighbor who lived off disability. Supposedly he’d hurt his back and could no longer work driving a school bus. He was able to lift rocks and cut down trees, though. He was able to drive his motor home on two-month road trips. He was even able to earn money doing repairs on sewing machines and vacuum cleaners. That doesn’t sound very disabled to me.

      The entire system needs an overhaul. I could rant a long time, and even offer solutions, but that would be going FAR afield from what I want this blog to be about 🙂

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