Doctor’s Appointment, 2032 (Part 1)

[10/7/13 update: not unexpectedly, the Mitt Romney for President website has been taken down, so you won’t be able to follow the links to that site provided below. There are plenty of other links that still work, though.]

No matter what happens in the future, one thing will remain constant: we’ll all get sick multiple times, and eventually one or more of those events will land us in a hospital. What happens then? In South’s version of America in 2032, it ain’t pretty.

I slogged into this swamp because Bel, Luis’ (Our Hero’s) wife, is an emergency-room nurse at a local hospital in north-central Orange County, California. It was useful to have someone around who could patch up Luis as well as give us a glimpse into what healthcare might become twenty years from now if South’s scenario comes to pass. (If you can’t remember the scenario, check here.)

How Things Are Now

American healthcare is now paid for by two main mechanisms: private health insurance, and various government-funded insurance schemes. Contrary to popular rightist opinion, there is very little government-provided healthcare in this country (mostly the Veteran’s Administration, Indian Health Service, military hospitals and clinics, state-run psychiatric hospitals, and some city- or county-operated hospitals and clinics).

I started to write this as a summary of the current state-of-play, but there’s just too much territory to cover and I doubt you’re up for another multi-part wonk blog extravaganza. So, let’s make a deal: I’ll give you links to the background information about how things stand now, and then I’ll talk about what’s coming up and how things change in the South scenario. Okay? Go!

Employer-Sponsored Health Insurance (ESI)

Individual Health Insurance

(Yeah, Wikipedia again. Tell you what – you come up with a better, more-or-less accurate single-page summary of this stuff, let me know.)

  • Health Care for America Now (advocacy group): Health Insurance Company Abuses (collection of reporting about bad behavior on the part of health-insurance companies)

Government-Sponsored Health Insurance

Patient Protection & Affordable Care Act (ACA) (aka “Obamacare”)

Done? Good, let’s move on.

How Else Might the System Change?

To say that conservatives have been hostile to Medicare and Medicaid since Day One is an understatement. This election year’s calls from the right to “reform” these programs out of existence are just a continuation of that record. At the same time, the Republican nominees for president and vice-president are on the record supporting the repeal of ACA. (In typical fashion, Mitt Romney has hedged his statements about this, and his official website touts several ACA provisions as part of “his plan”.) Should the Republicans win the White House and Senate in 2012 or 2016, here’s what they say they’ll do (wording from the official Romney website; my comments in parens):

  1. Limit federal standards and requirements on both private insurance and Medicaid coverage
  2. Ensure flexibility to help the uninsured, including public-private partnerships, exchanges, and subsidies (an ACA provision)
  3. Ensure flexibility to help the chronically ill, including high-risk pools, reinsurance, and risk adjustment (an ACA provision)
  4. Offer innovation grants to explore non-litigation alternatives to dispute resolution (code for arbitration, which nearly always rules against the complainant)
  5. Cap non-economic damages in medical malpractice lawsuits (a cap in place in California has effectively shut children, the elderly and the disabled out of malpractice litigation)
  6. Empower individuals and small businesses to form purchasing pools (an ACA provision)
  7. Prevent discrimination against individuals with pre-existing conditions who maintain continuous coverage (an ACA provision the insurance industry accepted only on condition an individual mandate is enacted; Romney opposes the mandate now even though he supported it as governor)
  8. End tax discrimination against the individual purchase of insurance (this means either allowing tax deductions for individually purchased insurance – which may contradict Romney’s tax proposals – or eliminating the deduction for ESIs)
  9. Allow consumers to purchase insurance across state lines
  10. Unshackle HSAs by allowing funds to be used for insurance premiums (an ACA provision)
  11. Promote alternatives to “fee for service” (an ACA provision)

As for Medicare and Medicaid:

  1. Block grant Medicaid and other payments to states
  2. Medicare is reformed as a premium support system, meaning that existing spending is repackaged as a fixed-amount benefit to each senior that he or she can use to purchase an insurance plan (borrowing from the Ryan-Wyden plan that Romney praises, cost growth for the fixed benefit would be limited to GDP growth plus 1%, which is far below the average growth of healthcare costs)
  3. All insurance plans must offer coverage at least comparable to what Medicare provides today (contradicts the “Limit federal standards and requirements” proposal in #1)
  4. Competition among plans to provide high quality service while charging low premiums will hold costs down while also improving the quality of coverage enjoyed by seniors (something that never occurred in the largely unregulated pre-Medicare insurance market)

Summary: trust the most dysfunctional insurance market in the nation to make everything right, and essentially privatize the most efficient health-insurance program in America (Medicare) and the one least likely to work in the open market (Medicaid).

That brings us up-to-date. In Part 2, I’ll talk about how all this goes together to make Nurse Bel’s working life a living hell.

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