Name:   copperline - Subject:   The Law of Unintended Consequences Date:   10/5/2013 6:54:36 PM

Major, i wish i could persuade you to take another look at the ACA.    First of all, you deserve to have access to a guaranteed health care system after serving in the military.  No argument from me there.   But the fact that military veterans have this benefit is evidence that we believe in the US that entitlement programs can be a good thing, and necessary for those that benefit from them.    The VA is, without a doubt, an example of a socialized government-run medical program.   And without it, millions of vets would be devastated both medically and financially.

i’m pretty familiar with this as i have worked with many, many vets over the years who were in need of medical help.   i’ve sat in the ER with them until i could arrange transportation to the nearest VA hospital with available beds, sometimes as far as 2 states away…… while we could have treated them down the hall in the same hospital if only our health system was designed differently.      i became really familiar with sorting out the intricacies of insurance coverages as each crisis was heating up.  i always thought the Vets were lucky in that there was always a VA to help them, whereas the fellow in the next room with no insurance had nowhere to go & not enough money for expensive treatment.   For that guy, my job was to get him out the door and protect the hospital from the legal and financial consequences of having yet another uninsured patient.   i sent many of them out the door with a prescription for meds i knew they couldn’t afford, and encouragement to find a doctor to treat them in spite of their inability to pay….    the hospital's bottom line was very much at risk thru their ER services where we treated people regardless of their ability to pay.... but because of their lack of insurance, i always felt it was inadequate and something of a charade.  

The reasoning behind having a VA medical system & Tricare is pretty sound:   if we want a ready and able military force, we need to be sure that anyone who is willing to make this sacrifice is protected in this way… and this includes their families.  Without it, i doubt very much an all-volunteer military could exist.   But there is another reason to provide this system to you and your family.   That’s because veterans could not get adequate medical coverage if they were forced to compete in the same marketplace, under the same conditions, as everyone else.    

 One way to think about it is this: if we want all retiring or disabled vets to have medical coverage, why don’t we simplify the system by just giving them an extra $500 monthly stipend to buy their own policies in the marketplace?    This would eliminate the need for a huge part of the federal bureaucracy, and let the vets benefit from the competitive advantages of having choices of multiple insurance carriers.   The law of supply and demand says that this should keep their premiums low.      That sounds pretty good, except it won’t work.   The reason it wouldn’t work is because insurance companies do not want to have expensive consumers on their membership rolls, and have a multitude of ways to either avoid or dismiss these consumers when they are identified.   Refining the membership rolls to decrease the number of people likely to NEED insurance is simply a more profitable way to conduct business.         injured vets wouldn’t be allowed coverage by commercial insurers… others often have pre-existing conditions and risk factors that are best avoided if you want to make a profit in the health care business.   Lifetime limits would also an impediment to their insurability.     So, a socialized system that guarantees their coverage is necessary to protect them.

i know you feel that eliminating rules about pre-existing conditions is already a good idea, i do too.   But please allow me to push the argument a bit further.   Why should one class of citizens have an entitlement program like this and others be prevented from doing so?   Why should vets be shielded from the realities of the commercial insurance markets when the rest of us are just as deserving of our health and medical care?    if the commercial insurance market isn’t good enough for Veterans, why is it good enough for the rest of us?

in my case, i am uninsurable, and the only insurance i can get is a policy through the State Employees Health Plan, though i have never been a state employee.  in this plan, the state of Alabama apparently has to offer financial inducements to Blue Cross or United Health Care to allow me to enroll for basic coverage.     My premium, for just me alone, is $800 per month.  i have no idea how much money it costs State tax payers to keep the program running, but it is the only option available for every Alabama citizen who can’t get regular insurance coverage.     And why am i uninsurable?    Well, because my MD noticed that i had high iron levels in my blood and sent me to a specialist who performed a genetic test.  This test showed that i have 2 genes associated with the possible development of liver cancer.  it’s a pretty common trait among white males of northern European heritage… 1 in 200 of us have it   (Hemochromotosis is sometimes referred to as the Celtic Disease).   And i am not sick in any way, all i have to do is give blood every few months to keep my iron levels low.   if i do that (and i will), i won’t ever actually get sick.   However, insurance companies look at genetic tests as firmly predictive, and i was denied all coverage because i am considered too risky to insure.    The many vets i know would have far more conditions that insurance companies would want to stay away from. 

From my POV, the Affordable Care Act is already a compromise that fails to correct some of the worst problems in healthcare because it leaves the insurance & Pharmaceutical industries very much in play.   They will continue to focus on ways to enhance their profits under the ACA.   i really would have preferred a single-payer system like Tricare for all of us, but a plan of that scope could not be pushed thru Congress.   So, we will have a hybrid system that won’t be socialized medicine at all…. For profit insurers will benefit as more people will have coverage, and a larger pool of premium-payers will fill the system.    Government’s role will be to prevent profiteering, not take the place of the insurance companies.    i don’t think anyone is being extorted by this, most middle class families already have coverage and have long accepted medical insurance as a necessary part of securing their finances.   From the early evidence coming in now from various insurance exchanges, many of them will actually have reduced costs.    And requiring people to have coverage is not going to be destructive, its going to make the system run and prevent folks from buying insurance just before they walk into the ER, and then drop their coverage when they leave.     A successful insurance pool requires maximum participation of both people who need insurance this moment, and those who don’t.     i expect that many small businesses will drop their employee insurance plans because they will determine that the administrative costs of this are outweighed by letting their employees purchase on the exchanges.   Ultimately, i think you will hear those business owners rather enjoy NOT having to negotiate new terms with insurance companies every year, and then having to explain to employees what has changed when they, or their families, need a doctor.