Stephen Blackwood's key piece on the ACA at the practical level –ObamaCare and My Mother's Care

The repeated and prolonged phone waits were Sisyphean, the competence and customer service abysmal. When finally she found a plan that looked like it would cover her Sandostatin and other cancer treatments, she called the insurer, Humana…to confirm that it would do so. The enrollment agent said that after she met her deductible, all treatments and medications””including those for her cancer””would be covered at 100%. Because, however, the enrollment agents did not””unbelievable though this may seem””have access to the “coverage formularies” for the plans they were selling, they said the only way to find out in detail what was in the plan was to buy the plan.

[My mother].. is a woman who had an affordable health plan that covered her condition. Our lawmakers weren’t happy with that because . . . they wanted plans that were affordable and covered her condition. So they gave her a new one. It doesn’t cover her condition and it’s completely unaffordable.

Though I’m no expert on ObamaCare (at 10,000 pages, who could be?), I understand that the intention””or at least the rhetorical justification””of this legislation was to provide coverage for those who didn’t have it. But there is something deeply and incontestably perverse about a law that so distorts and undermines the free activity of individuals that they can no longer buy and sell the goods and services that keep them alive. ObamaCare made my mother’s old plan illegal, and it forced her to buy a new plan that would accelerate her disease and death. She awaits an appeal with her insurer.

Read it all (emphasis mine).


Posted in * Culture-Watch, * Economics, Politics, --The 2009 American Health Care Reform Debate, Children, Drugs/Drug Addiction, Ethics / Moral Theology, Health & Medicine, Marriage & Family, Politics in General, Theology

8 comments on “Stephen Blackwood's key piece on the ACA at the practical level –ObamaCare and My Mother's Care

  1. Catholic Mom says:

    [blockquote] The “Affordable” Care Act is a brutal, Procrustean disaster. In principle, it violates the irreducible particularity of human life, and in practice it will cause many individuals to suffer and die. We can do better, and we must. [/blockquote]

    This is totally true, but so is/was our current form of healthcare insanity. The writer is staggered because the insurance company told his mother that the only way to truly know if something would be covered would be to buy the plan. But this is the way it has ALWAYS been.

    As someone with a child who uses a very expensive drug, I have spent hours and hours on the phone with agent after agent trying to figure out if a certain policy covered this drug. And this isn’t just for individual policies. Before my husband took his last job (at a prestigious research institute) , I spent hours on the phone with HR and the insurance company trying to find out if they covered the drug. They said they didn’t. In fact, one HR administrator said “look, we’re not going to cover every drug for every condition. Why should the whole research institute pay for a expensive condition that one person happens to have?”

    I had a ($30/k per year) individual plan that covered the drug but I was told that my son would be not be allowed to continue to be covered by individual plan if he was covered by an employer plan. Actually, it wouldn’t be allowed if he were only ELIGIBLE to be covered by an employer plan, which he would be if my husband took the job. And this was NOTWITHSTANDING that the employer plan did NOT cover the drug!!!

    I kept going up the line talking to people and I literally ended up talking with the head of the department that regulates health insurance in my state. She basically told me “tough luck.” My husband almost didn’t take the job because of this, but after me spending probably a hundred hours trying to figure out a work-around, he eventually did. Then, some weeks later, while still trying to negotiate a work-around that would allow me to keep my insanely expensive individual plan, I logged in to my husband’s health insurance account (you can’t get in without being enrolled in the plan) and browsed the formulary — and guess what? The drug IS covered. And my son has now been covered by my husband’s insurance for this drug for the last five years.

    Our system is a complete nightmare. I don’t believe ACA is making it one bit worse than it is/was. One thing I learned in business a long time ago — if you show no interest in fixing a problem, if you minimize the problem or deny that it exists — somebody else is eventually going to come along and “fix” it and you are very likely not going to be happy with the fix. If those who hate the ACA had spent less time constantly saying “we have the greatest healthcare system in the world, the only thing wrong with our healthcare system is that it needs to be less regulated” had done something to address the manifold horrors of the system (or non-system, as it were) we wouldn’t have the ACA.

  2. Sarah says:

    RE: “But it is precisely because health care for 300 million people is so complicated that it cannot be centrally managed.”

    Unlike what appears to be Catholic Mom’s principle above, I agree with the sentence above. The more a product or service is “centrally managed” by the Federal government, the worse. And so, given that the ACA vastly increases the central management, it is significantly worse than the “old” system which was also very very bad, because it also was centrally managed.

    Ah well — either those who value limited government, free enterprise, private property, the Constitution, and individual liberty will *win* more elections, or lose more elections. And that will tell the tale as far as whether we delete the ACA *and* reform the old system, or we don’t.

  3. Catholic Mom says:

    People as a group rarely, I would say almost never, make political decisions based on pure a priori ideology. They look at what works and what doesn’t work. Communism was not overthrown because of a deep abiding belief in limited government, free enterprise, private property, the Constitution, and individual liberty. It was overthrown because it didn’t work. If Communism had delivered on what it promised, half the world would be Communist right now.

    IF you have a view of a healthcare system that works, then IF you want people to adopt your view, then you have to ARGUE your view (that is, show how it actually works, as opposed to stating that anyone who doesn’t agree with your view is anti-Constitution). And the very very best way to do that is to refer to some relatively large place somewhere in the world in which healthcare works the way you think it should work, and then let people measure how successful that has been.

    Of course, you can make the argument that government regulation of any type exists everywhere, making it impossible for your “ideal” system ever to have a fair chance. This is, of course, exactly how Communists defended Communism in the Soviet Union and Eastern Germany — “it isn’t PURE Communism — which would work beautifully — it’s diluted with too much capitalism and anyway, the constant military threat of the West makes it impossible to practice pure Communism.” OK — whatever. In short, there is no model where Communism “works.”

    Now, you may not feel that you have to do any of this — that it is not incumbent on you to make a practical (as opposed to ideological) argument demonstrating why your view of healthcare would actually work, much less provide a single example of a relatively large region anywhere in the world where it does work. But the end result is that you will continue preaching to the choir and one “fix” after the other will continue apace.

  4. David Keller says:

    This is so much simpler. The problem with American health care pre-ACA was NOT access. I could get an appointment with Sloan-Kettering with a phone call. The problem was cost; i.e once I got the appointment could I pay for it? The ACA went after the problem of acesss, which didn’t exist, and ignored cost. Now we have a system which is limiting access and can’t control costs, which is, IMHO, why the constitution doesn’t give Congress the authority to regulate health care. Even John Roberts knew that, which is why he called it a tax, rather than health care regulation. Now, why don’t we ask any congress person who voted for it, why he/she voted for something that hadn’t ever been read. The fact is, there were several key Dems who could have stopped it, but didn’t have the guts. I haved always contended had Evan Byah voted against it, the people of Indiana would have carried him on a sedan chair down Meridian Avenue and he’d be President. Of course, he has a pension and his own congressional medical care plan, so why bother?

  5. Paul PA says:

    Congress/the government limits our access to all sorts of things. Many people (from my perspective most who have sense) thought that this was a bridge too far. The act seems to be a high cost to pay if = as Catholic Mom says – it just didn’t make it worse. I think that that those who experience this will either become numb to it’s failures or will throw out those who have imposed it on us. I agree with David that this addressed the wrong problem.

  6. Sarah says:

    RE: “IF you have a view of a healthcare system that works, then IF you want people to adopt your view, then you have to ARGUE your view (that is, show how it actually works, as opposed to stating that anyone who doesn’t agree with your view is anti-Constitution).”

    Hi Catholic Mom — I’m sure you’re right, but there’s nobody on this thread that I wish to persuade, since those who share my values and political worldview are already persuaded, and those who do not won’t be convinced by all the practical arguments in the world. ; > )

    The only thing I wished to do was to assert my belief — and in the first paragraph I asserted my opinion about the *practicality* of centrally controlled healthcare [it’s not, as is being beautifully demonstrated in spades right in this country], and then in the second I asserted my opinion about how — pragmatically — that non-working centrally-controlled healthcare system would be overthrown, or not, and replaced with something that works, or not.

    Those who don’t share my political worldview or values and in fact support their antitheses won’t be voting for those candidates *ever*, no matter what is practical, or working, or not.

    So the only group that’s left to actually attempt to persuade about the *workability* of a market-based healthcare system are those who 1) don’t really share my political worldview and values, but 2) don’t support their antitheses either. The good news is . . . with the vast amount of pain that those people are experiencing right this moment, I doubt very much that they will want a “moar [sp] central-planning please!” solution any time soon.

  7. Catholic Mom says:

    You are assuming 1) the vast number of people are experiencing vast pain from the ACA and 2) their response to this will be to say “oh my gosh, we need a much less centrally regulated healthcare system.” I’m not sure #1 is correct and I know #2 is not. For example, Medicare, a totally centrally managed program, is extremely popular in this country and any politician who proposes significant reductions in benefits commits political suicide. Again — people don’t care whether or not something is centrally managed, locally managed, or completely unmanaged. They just know when its working for them — or not.

    I think you’re living in a dream world if you think problems with ACA will cause large numbers of people to flock to conservative candidates begging them to repeal ACA and go back to the “good old days” (whatever those might have been) without some very specific, very practical, very demonstrably workable alternative plan. And I have not seen or heard of one.

  8. Sarah says:

    RE: “I think you’re living in a dream world if you think problems with ACA will cause large numbers of people to flock to conservative candidates begging them to repeal ACA and go back to the “good old days” . . . ”

    We’re gonna see. I’m comfortable with the country going either way.