tag:blogger.com,1999:blog-3197794574961892031.post4832773151735377066..comments2023-04-22T02:57:46.361-04:00Comments on Diary of an Occult Librarian: Some thoughts on healthcareGwendolynhttp://www.blogger.com/profile/10066810999619502802noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-3197794574961892031.post-41996639192160634632017-05-09T15:15:01.345-04:002017-05-09T15:15:01.345-04:00Very good analysis. I've been self-employed fo...Very good analysis. I've been self-employed for most of my working life, so for many years I paid for what insurance I could afford, usually through a group. This was major medical only, which is to say it covered almost nothing. When my monthly premiums went from $272 to $643 (it was 17 years ago and I still remember those numbers), it was a no-brainer: I dropped it. I was uninsured till Romneycare was implemented in Massachusetts. Whew. I went from Romneycare to Obamacare (the bureaucratic hassle was <i>immense</i>), then last June I turned 65 and went on Medicare. Huge sticker shock! I'm now paying about 2 1/2 times what I was paying under the ACA for roughly the same coverage. The problem is that the subsidies under the ACA go up to about 400% of federal poverty level, but with Medicare you have to be close to FPL to qualify for anything. That needs fixing. Dentistry needs to be included. But single-payer is the only way to go. I hope the Trumpcare travesty will persuade more people of that.Susannahttps://www.blogger.com/profile/12859415775307390408noreply@blogger.comtag:blogger.com,1999:blog-3197794574961892031.post-15047535599820060402017-05-09T10:40:36.092-04:002017-05-09T10:40:36.092-04:00I agree with your analysis, entirely. And I suspec...I agree with your analysis, entirely. And I suspect that some folks are unaware of parts of the relevant history. Here are a few:<br /><br />Employer-paid health insurance began as a way for employers to reduce the payroll taxes they paid while still offering 'competitive' compensation. Instead of paying you (in made-up numbers, take them as examples) $4000 more per year and letting you buy your own health insurance, they negotiated with Blue Cross (at first the only provider) to pay $1500 per year for the same coverage you could buy on the open market for $4000 ... and take that cost as a tax deduction for the business, not pay the payroll tax on even that $1500, and also keep your income tax lower. Looked like a win-win-win for all concerned, right?<br /><br />Except that what no one mentioned out loud (where employees could hear it) is that this would also reduce employee turnover by tying you to your big-company job. Because in those days little companies couldn't negotiate any such thing.<br /><br />Or how about the fact that the early health insurance policies only covered surgeries and other big-ticket items, but left well-baby visits and other preventive care for you to pay by yourself? This seemed a good idea at the time, but turned out to encourage people on tight budgets to skip preventive care and hope for the best, knowing that if they got "really sick" the insurance company would pay for it. And mostly not thinking about the possibility that some preventable illnesses might prove to be unfixable.<br /><br />So then, as a culture, we 'fixed' that problem by having some insurance plans pay for more and more preventive care ... and then we started judging doctors by how many of their patients conform to measurable norms for things like blood pressure, blood sugar, weight etc. Which we now know has resulted in some doctors and hospitals being penalized for taking care of people with significant illnesses or injuries or intractable conditions.<br /><br />The more we try to tinker with the system, the worse it gets. Time for single-payer.<br /><br />Congress won't do that until they can find a way to salvage the jobs of the CEOs and other corporate executives at the big insurance companies. Maybe we should be finding significant, useful work for those folks to do.Maggienoreply@blogger.com