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Insurance Against The Insurers
Want to fix the issues with the Affordable Care Act? Get corporations out of the picture
This year will mark the 50th anniversary of graduation from my school of nursing. Many amazing medical advances have taken place in those 50 years, but not all that has changed has been beneficial.
I entered the nursing profession when medicine was a vocation, and the highest priority was the welfare of the patients. I believe that remains the highest priority of most medical professionals today, but the landscape of the medical establishment has changed. Giant corporate insurance companies, pharmaceutical companies and hospital conglomerates presided over by executives and administrators with MBAs rather than MDs now dominate what is the big business of medicine. Actual caregivers are increasingly cogs in a machine where customers are the investors and the real product is money.
An inefficient, profit-driven, multi-payer insurance industry is not by any means the sole source of the dysfunction, but it lies at the heart of the problem. There is no effective control of medical pricing, and the resulting costs of every product and service have become unsustainable. The price of insurance itself is beyond the reach of an ever-larger slice of the population, and the value of the insurance diminishes as the industry constantly devises new ways to shift more costs back to patients. Way too many people find themselves physically healed, but financially eviscerated. This is not acceptable.
The Affordable Care Act was an earnest attempt to combat some of the problems, but the insurance industry was heavily involved in its design. It contains a number of good individual provisions and has reduced the number of people with no medical access, but its overall success has been decidedly mixed.
The story of Matthew Stewart, a 29-year-old graduate student from Fort Worth, Texas, is one example of the ACA's limitations. He led a healthy lifestyle and was covered by a gold-level ACA exchange insurance policy. Then he experienced a sudden onset of autoimmune hepatitis.
He went to an urgent care clinic intensely ill and vomiting blood. He was transported by ambulance to the nearest hospital, in no condition to question where he was being taken.
That hospital was out of his insurance company's network.
Even though this was a life-threatening emergency and he was transferred to an in-network hospital as soon as his condition permitted, his policy provided no out-of-network coverage and the resulting hospital bill exceeded his annual gross income.
His only viable option was to declare bankruptcy.
Since then he has been suffering from liver failure, which requires him to be under close, consistent care from a liver specialist. His insurer has dropped out of the exchange this year, and the two remaining insurers have either an unaffordable deductible or no in-network liver specialists.
He would qualify for Medicaid if Texas had accepted the Medicaid expansion, but it has not.
He hopes to flee to another state, but it will take him months to untangle his financial affairs in Texas and scrape together enough money to move. Without adequate medical management, he is not certain he will survive that long.
High deductibles and narrow provider networks, two of the major complaints with ACA policies, are innovations of the insurance industry, not the law itself. No other developed nation on earth permits a for-profit insurance industry to control access to basic medical care for its citizens.
The American people must demand that the funding mechanism of our health care be taken from those who would use it to exploit the sick and vested in a public or quasi-public agency to be administered not for profit, but for the common good.
