Black Jet Theory – Volume 2020-18 – Why Healthcare Reform Never Happens.
September 4, 2020 by Marshall Snipes
Do you ever wonder why healthcare reform never happens? We continue to debate, discuss and become frustrated with the “system”. The Affordable Care Act also known as Obamacare was supposed to fix what ailed us. Then the Supreme Court weighed in and complicated matters[1] ruling that part of the Affordable Care Act was unconstitutional. Somehow, we still seem to wrestle with the same old problems. The debate around the problems ranging from access and affordability to poor results and confusion never seems to result in solutions. There have been plenty of articles, news reports and social media written about the issues at hand but there never seems to be any momentum to make progress. I think I know why.
First, healthcare is complicated. “In the United States, there are currently more than 900 health insurance companies that offer medical coverage”.[2] In addition, there were over 56,000 employers who were self -insured in 2016.[3] Each of these health insurance plans along with the various governmental health insurance plans (Medicare, Medicaid, etc.) all have potentially different coverages, eligibility requirements, co-pays, and deductibles. Even with assistance from technology, the confusion, errors and disputes are massive. Health care providers and patients are constantly battling with insurance companies to determine who pays what and whether or not an episode of care is even covered under the health plan in question.
“It is estimated the added cost of this enormous collection effort adds somewhere between 15 and 20 percent overhead to our system.”[4] It must be complicated if 20% of the cost of healthcare is figuring out how much will be paid and who will pay it. As patients, we are supposed to decipher this complexity through something called an EOB – Explanation of Benefits. If you’ve ever tried to interpret an EOB you know what we mean when we say complicated, confusing and frustrating. Throw in “surprise billing” – the ability for the providers to bill you for the amount the insurance company did not pay even if its greater than your deductible and co-pay and you have a system that’s become cumbersome and out of date in the modern era of technology.
As a patient, if you try to determine in advance of a surgery or other form of treatment what it’s going to cost, then YOU have to determine the amount you will ultimately pay with assistance from the insurance company to determine eligibility, co-pays, deductibles and surprise billing possibilities. No one describes this process as user-friendly. All of these complicated calculations come at a time when the emotion of the medical problem is at its peak.
Second, it’s emotional. Any reform of healthcare in the United States that smacks of lessening coverage, withholding treatment or “throwing granny over the cliff” meets with significant pushback from the general public. Years ago, my mother was diagnosed with cancer, a type of cancer that was considered terminal. Very few people with this type of cancer live very long. My mother was in her mid-seventies and by today’s medical standards, entirely too young to die. After surgery, the recovery was long and drawn out, painful and it significantly diminished her quality of life. She went into remission and we were hopeful that she had defeated this ugly disease. Then the cancer returned. We were devastated when the doctor told us there was nothing further, he could do. We reacted emotionally and decided we needed a second opinion. We wanted to try whatever it took, however long it took. We were not to be denied. We were emotional and that emotion clouded our thinking. My mother intervened and said, no more treatment, take me home. I’m at peace with God and with my situation. She died peacefully a few months later at home with her family.
When healthcare reform touches the nerve of life-threatening medical problems that people are dealing with every day, there is a tendency to pushback. Healthcare is personal. When changes to healthcare are viewed as a reduction in access or treatment, people will react.
Third, it’s political. Given the chasm between the two political parties in the United States, reaching consensus on any issue not just healthcare seems out of reach. Healthcare is a $3.6 trillion-dollar industry with many of the participants in the system making a lot of money. Insurance companies, drug companies and many health systems are making significant profits. Those same companies and healthcare systems employ hundreds of lobbyists, make millions of dollars of political contributions and buy billions of dollars of advertising. That’s a lot to overcome when discussing reform.
The two presidential candidates, Joe Biden and President Donald Trump have two very different views of healthcare. Biden has an elaborate healthcare plan on his website that expands on the Affordable Care Act and infuses more government into the healthcare system.[5] Trump championed the effort to repeal the Affordable Care Act. They couldn’t be more opposite. But yet neither, in their respective party conventions the last couple of weeks, had much to say on healthcare other than the current crisis of COVID19.
Biden’s convention and speech came first on August 20. In his 24-minute speech he had exactly two sentences on healthcare. Both sentences were attacks on Trump. “With a health care system that lowers premiums, deductibles, and drug prices by building on the Affordable Care Act, he’s trying to rip away.” And later he said “And the assault on the Affordable Care Act will continue until its destroyed, taking insurance away from more than 20 million people — including more than 15 million people on Medicaid — and getting rid of the protections that President Obama and I passed for people who suffer from a pre-existing condition.”[6]
Trump’s one hour and ten-minute speech the following week, touted accomplishments and criticized Biden. In touting his accomplishments, he said, “Last month, I took on Big Pharma and signed orders that will massively lower the cost of your prescription drugs. And to give critically ill patients access to lifesaving cures, we passed the decades long-awaited RIGHT TO TRY legislation. We also passed VA Accountability and VA Choice.” Further, he said, promising future changes, “We will END surprise medical billing, require price transparency, and further reduce the cost of prescription drugs and health insurance premiums.” And finally, attacking Biden, “Joe Biden recently raised his hand on the debate stage and promised to give away YOUR healthcare dollars to illegal immigrants.”
That’s not a lot of airtime for either candidate on an issue that many believe is the major issue of the campaign. It should be noted the current pandemic was mentioned but again both candidates were miles apart in their philosophy and approach. The Black Jet Theory[7] would suggest that healthcare reform, other than any pandemic related changes, would not be forthcoming anytime soon. Healthcare reform is too complicated, and the unexpected consequences are too hard to predict. Healthcare reform is too emotional leaving rational debate to sound bites. The country is divided politically, and the pandemic has escalated the political division even further. And once again healthcare reform becomes elusive.
Don’t take my word for it, think for yourself.
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[1] Supreme Court of the United States. National Federation of Independent Business et al v. Sebelius, Secretary of Health and Human Services, et al. Retrieved September 2, 2020. https://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf.
[2] Price S. Largest Health Insurance companies of 2020. Retrieved September 2, 2020.
https://www.valuepenguin.com/largest-health-insurance-companies
[3] Department of Labor. Advanced Analytical Consulting Group, Deloitte. Self-Insured Health Benefit Plans 2019 Based on Filings through Statistical Year 2016. January 7, 2019. Retrieved September 2, 2020. https://www.dol.gov/sites/dolgov/files/EBSA/researchers/statistics/retirement-bulletins/annual-report-on-self-insured-group-health-plans-2019-appendix-b.pdf.
[4] Hupfeld S. Political Malpractice How the Politicians Made a Mess of Health Reform. Published by Tate Publishing & Enterprises, LLC. 2012.
[5] Retrieved September 2, 2020. https://joebiden.com/healthcare/
[6] Biden J. Speech at the Democratic National Convention. August 20, 2020.
https://www.cnn.com/2020/08/20/politics/biden-dnc-speech-transcript/index.html
[7] Snipes M. The Black Jet Theory is “the notion that most of what currently happens, when viewed through the filter of common sense and critical thinking, leads to a different conclusion, than the widespread view of current thinking by those who control the dissemination and content of information (academia, the media, politicians and other “experts”). Black Jet Theory – Volume 2020-1, May 1, 2020. Article upon request [email protected].