Health Insurance Is Not a Product

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An excerpt from a piece by Egberto Willies in Daily Kos:

One of the biggest problems with health insurance is that we allow Republicans to treat it as if it is a consumer product.

It is not.

Republicans love to talk about leaving health insurance to market forces. Their ideological blindness and callousness leads them to believe that what is good for a capitalist market is always right for the individuals it purports to serve. The reality is that we have made the capital markets our religion, as opposed to treating it as a tool that can make life better for us all.

A company does not sell a product that is not profitable. The fiduciary responsibility of a business in a capitalist market is to its shareholders, not the customer. The client is nothing more than a means to transfer wealth to the shareholder and the executives running the business.

A company cannot make a profit on an unaffordable product. Prices must rise or costs of manufacturing the product must go down, or the product will cease to exist. That’s what is happening to health insurance under Obamacare. Some insurance companies raised their prices, while some just abandoned the health insurance 'product.' Because proper regulations were finally in place, they could not make the product less expensive. In other words, Obamacare did not allow health insurance companies to sell their customers a crappy insurance policy.

Republicans argue that it is a lack of choice that allows these businesses to charge exorbitant premiums. They claim it is overregulation that causes health insurance companies to have to provide services people don't necessarily want. They say that disallowing interstate health insurance purchase reduces competition and competitive pricing.

There is some truth in those statements—but that’s only because as long as health insurance is seen as a product, that abridgment of market forces is detrimental to the company's bottom line, and also to insurance pricing for Americans. . . .

Here is the reality: We do not decide when we get sick. When we get sick, we cannot just shop around for the hospital and doctor that will provide the best price to treat a disease we do not yet know we have. Sickness does not know our socioeconomic condition, so having a ‘choice’ to purchase a plan we can afford means we get wealth-based health care.

Health insurance is not a product. Selling it that way is immoral, un-American, and downright evil.

What I Say: Your Head Trucker, who has endured a great deal of poverty in his life, and watched his loved ones suffer and die with precious little help from the free-market system, believes in a much-expanded and much-improved Medicare for All - by which I mean, a single-payer system, which could be funded and provided by various means, but which would automatically cover every resident of the United States from cradle to grave without limitations, exclusions, or premium payments. Ideally, it should be free at the point of access, though I could support a sliding scale for nominal co-payments, based on income.  Anything less is inexcusable and immoral in this, the richest nation on the face of the earth.

All medically necessary care and services, including preventive exams and treatments, physical therapy, mental health services, prescription drugs, and appliances, as well as hospital and residential care, would be provided under a nationally determined list of allowable benefits to patients. Doctors, clinics, and hospitals could be either government employees or private providers who agree to accept the standard compensation for services. Patients would not be involved in the billing process at all.

The whole program would be funded either out of general taxation, or with the help of a nominal withholding tax on wages. But everyone young and old would be fully covered at all times, regardless of whether they were employed or not.  Private insurers would be forbidden from competing with Medicare on any benefits covered by the national program.

The ultra-rich - like snooty rich-kid pig Jason Chaffetz (R-Utah) - who can't bear to sit in ordinary waiting rooms with the commonality could use their gold-plated private doctors and hospitals, who could charge whatever the fat-cat market would bear - but they could not also receive any payments from Medicare.

Or maybe there's a better way than all that to cover everyone - I am no financier, but I do believe in the three principles upon which Britain's National Health Service was founded:

• That it meet the needs of everyone
• That it be free at the point of delivery
• That it be based on clinical need, not ability to pay

I see that the total expenditure from all sources on healthcare in the United States in 2015 was $3.2 trillion.  (For comparison, the total annual payroll in the United States, including government employees, was $5.9 trillion in 2014; and total federal spending in 2015 was $3.7 trillion.)  That's a lot of money, but I'll wager at least half of it is wasted on insurance middlemen and their bulging profits, not to mention mindless paperwork and the utterly needless drug advertisements that flood the airwaves and Internet night and day. All other developed countries spend much less per capita on healthcare than the U.S. does, and get better outcomes, too:

Click to enlarge.

And then there is the combined $2.1 trillion net profits of American corporations the year 2015, which benefit immensely from our skilled, educated workforce, high-class infrastructure, and natural resources - your Head Trucker thinks that instead of paying fantastic salaries and bonuses to the execs, the big companies should be doing some substantial good for the general public.

Chart from Statista.com; click to enlarge.

USA Today reported that just 28 big firms, or 6 percent of the total, made fifty percent of those profits in 2015.

I don't know for sure the best way to finance universal coverage, but what I do know is that there is plenty of money circulating around this old world, and the big-money boys in their gold-plated towers can always find a way to finance every whim and extravagance and obscene profit they want, and the public be damned - so they can sure can sure as hell figure out a way to finance Medicare for All if they are made to, and if they don't - may God reward them as He did Dives.

It's instructive to check out this comparison of various national healthcare systems from Wikipedia, with links to many other sources of information. Also enlightening is this comparison of U.S. and Canadian healthcare systems.

Physicians for a National Health Program has a proposal for a single-payer system that seems well thought out to your Head Trucker.

IRS Recognizes All Married Gay Couples Across the Country

So much momentous, life-changing good news in one day, I can hardly take it all in, boys. After waiting all these many years for Change, now that it's arrived, it just seems unreal - am I waking or dreaming?

First, via Freedom to Marry:

Today, the Department of the Treasury and the Internal Revenue Service announced how they will implement the June 2013 Supreme Court ruling declaring the central part of the so-called Defense of Marriage Act unconstitutional. The Treasury Department and the IRS announced that all legally married same-sex couples will be fully respected by all federal tax programs, including income tax, gift and estate taxes, deductions, exemptions, retirement accounts, and child tax credit.

The ruling will be applied to same-sex couples who married legally in any U.S. state or international country that has approved marriage for same-sex couples. All couples - no matter which state they live in (even if they live in a state that discriminates against their marriage) - will be respected for these federal tax programs.

Treasury Secretary Jacob J. Lew announced the decision today. He said:

Today’s ruling provides certainty and clear, coherent tax filing guidance for all legally married same-sex couples nationwide. It provides access to benefits, responsibilities and protections under federal tax law that all Americans deserve. This ruling also assures legally married same-sex couples that they can move freely throughout the country knowing that their federal filing status will not change.

Wonderful news and a great advance for equality and civil rights - but note that the ruling does not apply to couples in domestic partnerships or civil unions. Of course, every couple should seek professional advice on how best to make use of these new financial benefits.

What does this mean for you? Well for starters, bud, even if you aren't particularly well off, it means that if your husband dies and you inherit the house, you do not have to pay income tax on the value of it, or any part of his estate you inherit, if you guys were married. And that, fellas, is truly a big fucking deal.

For another thing here and now, if you have health insurance through your husband's employer's plan, it will no longer be counted as income to you, so you won't have to pay income tax on it any longer.

Evan Wolfson has compiled a comprehensive list of statements and policies from various federal agencies in the wake of the Windsor ruling here. At the time of this writing, it seems that Social Security for the near future will base benefits on whether a couple lives in a marriage-equality state or not, but that might change, so stay tuned.

See also these very helpful factsheets on Life after DOMA, and what it means for you in terms of bankruptcy, family and medical leave, federal student aid, and other pertinent issues.


Update, 4:45 p.m.:  More good news, via the Advocate:

The federal Department of Health and Human Services announced today that legally married same-sex couples on Medicare will be eligible for equal benefits and joint placement in nursing homes around the country.

In the wake of the Supreme Court's landmark ruling in June striking down a key section of the so-called Defense of Marriage Act, HHS secretary Kathleen Sebelius said today's announcement is just the first in a series of changes forthcoming in how the department deals with married same-sex couples.

"Today, Medicare is ensuring that all beneficiaries will have equal access to coverage in a nursing home where their spouse lives, regardless of their sexual orientation," said Centers for Medicare and Medicaid Services administrator Marilyn Tavenner in a statement. "Prior to this, a beneficiary in a same-sex marriage enrolled in a Medicare Advantage plan did not have equal access to such coverage and, as a result, could have faced time away from his or her spouse or higher costs because of the way that marriage was defined for this purpose." . . .

The new guidelines revise this standard, confirming that Medicare now applies equally to all married couples, regardless of where the couple resides. That's important for legally married gay and lesbian Medicare recipients who reside in a nursing home in a state that does not embrace marriage equality, since they will still be eligible for the same benefits as opposite-sex couples.

Update, Friday, 12:30 p.m.: Yesterday, a federal district judge in California struck down the provisions of Title 38 of the United States Code that limited veterans benefits to heterosexual couples. According to Freedom to Marry,

The judge wrote that there was no rational basis for the Department of Veterans Affairs to bar same-sex spouses from receiving these protections - that it is not related to the goal of gender equality, to any military purposes, or to the military's commitment to caring for veteran families. The judge explained that the definition of "spouse" in Title 38 of the Code of Federal Regulations is unconstitutional.

For now, the ruling is limited to married same-sex couples living in states with the freedom to marry. We await further clarification on how military families living in the 37 non-marriage states will be treated.

The case is Cooper-Harris v. United States, and here's a sweet video about the plaintiffs: