I first realized how broken America's healthcare system was around the time I turned 30. I was writing the checks for the premiums for Skotos' health insurance, and I was seeing the costs rise dramatically year by year. It was having a major impact on our bottom line as our fees literally doubled over the course of several years.
However, K's issues with health insurance were more notable. She applied for private insurance and she was denied due to pre-existing conditions. It was nothing of particular note at the time, just rare fainting and chalazions (eye styes), but the insurance industry had absolutely no incentive to offer insurance to someone who didn't appear to be in picture-perfect health, so they didn't. It was one of the worst examples I've ever seen of capitalism applied to basic human services, to the deficit of humanity.
We were able to get K. on Skotos' insurance, with fees paid out of our pocket. But if anything that amplified my impression of the core problem. I increasingly realized that our health care — our health assurance
— depended on being employed with a company. It made ideas like freelancing and even moving very difficult, because either of those decisions could break our ties to our employer-based insurance system.
In other words, it was heathcare serfdom
, locking me to the regular system of employment and making it difficult to go too far afield from the location of the company that I wanted to work with. Perhaps the tie was harder to see than those of serfs with their land in the Middle Ages, but it was there all the same.
America's healthcare serfdom ended on March 23, 2010. The Democratic Congress restored the right of mobility to the population by ending insurance companies' ability to reject applicants, to reject claims related to pre-existing conditions, or to charge more for high-risk patients. As is appropriate in a civilized country, Congress ensured that everyone would help each other, with the healthy supporting the sick. Using a complex system of payments and tax rebates, they also made it possible for everyone to get health insurance.
It made freelancing a real possibility, without living under the Damoclean sword of medical bankruptcy. It also fit with the modern idea of a distributed office, allowing employees spread across the United States to each access guaranteed health insurance in their own state.
Skotos changed over to health-insurance-exchange insurance a few years ago. Admittedly, it's far from perfect. The costs are too high and the networks are too narrow. But it wasn't horrible for relatively healthy people, and it made less-traditional business very possible. More importantly, it offered a way to cut the too-strong tie between employment and healthcare.
For the first time in nearly a decade I was able to breathe a sigh of relief. Cost increases finally flattened out, and I no longer had to worry about what to do about medical insurance if a situation arose where my company or my employment would no longer qualify for an employee-backed health insurance.
Meanwhile a new idea fell together for K. and me personally: a move to Hawaii. It was May or June this year when we settled upon this as our intention, for a few years hence. And healthcare was never even a concern, because I knew I could just transition from a plan on the California exchange to a plan on the Hawaii exchange with little problem.
Enter November 8, 2016. Donald Trump won the presidency after running on a chaotic and varied platform that, among other things, promised to dismantle the AMA.
Twenty-two million Americans depend on it. It establishes right of movement, eliminates health serfdom. It opens up new possibilities and removes old anxieties. But it's been the irrational target of hatred for Republicans for six and a half years, so there's every indication it will be gone in a couple of months. Donald Trump's minions even updated their plans
on the topic a few days after their unexpected win.
So where do we go from here?
Are we going to return to the bad old days when loss of a job could (eventually, after COBRA runs out) result in the loss of insurance? Will we, the people, once more be bound to our jobs as healthcare serfs?
Trump claims he's going to replace it, but the only specifics on his web site talk about HSAs, which I've always seen as a fancy way of saying, "I don't have insurance."
The ACA was the biggest social entitlement of my generation. It addressed the worst of the human needs not addressed by our then-current government.
If things are rolled back to March 22, 2010, it's going to be ... heartbreaking
Frustratingly, this proposed repeal is built on lies and unsupported hyperbole that the Republicans are telling about the system. Donald Trump's web site claims that the ACA is unsuccessful due to "rapidly rising premiums and deductibles, narrow networks".
I'd certainly agree that the narrow networks are troublesome. Just last year I wrote about the unacceptable distance I had to go to find an urgent care system. They literally told me to go to Sacramento. I had similar issues with finding an allergist, and ultimately decided to just punt the problem by not dealing with the issue. That's a problem that needs to be fixed.
However the low level of premium increases from 2011-2017 have been a godsend when compared to the decade before. They literally made it possible for me to keep doing what I was doing, what I love, even if the resulting coverage wasn't what I would have liked.
But the worst lie may be the claim that the Republicans can keep the "good" parts of the ACA, like the protection for pre-existing conditions and the ability for young adults to stay on the parents' insurance. Because without that much-hated mandate and without a complex system of risk corridors that moves some monies to the insurance companies shouldering excessive risk due to sicker patients ... it all falls apart.
So maybe the Republicans don't actually kill the pre-existing condition protections which are what protect us from healthcare serfdom, but if they drop the elements that make it possible, the whole system falls apart. And then the ACA dies a slow, shuddering death over a decade instead of a transitional death in two years, as the Republicans proposed last year.
How does this affect us personally? It's hard to say, but it fills me with dread.
K. is no longer dependent on private insurance. She's managed to access Medicare. Mind you, Paul Ryan has been wanting to kill Medicare for years, and he's already stated it's at the top of his list come 2017. So, that's another potential disaster come inauguration day. But there's some indication that he might leave Medicare for current recipients, and if so, things might be OK for a time. And it'd be a foundation to rebuild Medicare after his voucher system crashes and burns.
Instead, my situation will be the trickier one this time. I find it unlikely that my current insurance carrier will want to dump me, because I'm pretty healthy and California itself has some decent protections for insurance costs. I also don't get any subsidies, so all I need is for the insurance company to keep treating me fairly.
But if the ACA is truly gone come 2017 (or 2019), our plans to move to Hawaii just got a lot harder, because I'd need to sign up with a new insurance carrier then. And I have high blood pressure, and that's a pre-existing condition.
It's probably a bit higher as of November 9, 2016.