A Letter to a Friend (or, I’m Sorry I Lost My Temper Last Night”)

Sibling RivalrySo I did something last night that I’m not proud of. I got into an argument – complete with raised voices – with a friend. Over health care and the Affordable Care Act (ACA), of course. (Note that he continually called it “Obamacare” in a somewhat sneering tone, which, as those of you who read my blog regularly or know me, know I consider a derogatory term for a very important piece of legislation).

I felt terrible after we left and tossed and turned all night coming up with things I wished I said (not to mention wishing I hadn’t lost my temper).

So I decided to write my friend a letter via this blog.

Dear Friend:

I am really sorry about last night’s discussion, er, argument. I should have remained calmer (I’m blaming it on the martini you made me, which, by the way, was very, very good). So here is a cooler version of responses to some of the points you made.

The government should not be paying for health insurance.

Well, I notice that you are quite happy to have Medicare Part A (hospitalization) right now, and, I assume, when you stop working full time you’ll start paying premiums (about $34 a month) for Medicare Part B. Who do you think is providing that insurance?

People who are uninsured can walk into any emergency room and get care.

Not true. The Emergency Medical Treatment and Labor Act (EMTLA) requires only that emergency departments treat the emergency medical conditions of anyone who comes to the ER, although everyone is entitled to a screening.

An emergency medical condition is defined as “a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual’s health [or the health of an unborn child] in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs.”

Obviously, the flu, high blood pressure, depression, strep throat, routine prenatal care, etc., are rarely emergencies. But hey, EMTLA is great if you have a stroke because you couldn’t afford the medication to control your high blood pressure.

The law has turned hospitals into “the defacto national health policy for the uninsured,” according to the American College of Emergency Physicians. In 2012, that added up to between $46 billion and $51 billion in uncompensated care. This, in turn, has led to the closing of ERs across the country – limiting access to everyone, not just the uninsured. The good news is that thanks to increased coverage through the ACA, about 10 million people who previously did not have health insurance are now insured, and hospitals are seeing their uncompensated care costs drop.

And, by the way, someone has to pay for that uncompensated care (hint: it isn’t the federal government, which has never funded EMTLA). Instead, it’s those of us with commercial insurance, who are paying about $1,000 a year in increased premiums, called the “hidden health tax.”

My health insurance premium increased because of “Obamacare.”

Quite doubtful. You work for a state agency. Health insurance provided by large employers like yours is not subject to the “essential health benefits” requirement of the ACA (which says that health insurers on the individual exchanges and in the small group market, defined as less than 50 full-time equivalent employees, must include these 10 conditions).

Here’s what the 2014 Kaiser Family Foundation employer survey found about premium increases for employer-provided health care in 2014:

“The average annual premiums in 2014 are $6,025 for single coverage and $16,834 for family coverage. The average family premium increased 3% in the last year; the average single premium, however, is similar to the value reported in 2013 ($5,884). Family premiums have increased 69% since 2004 and have more than doubled since 2002. However, the average family premium has grown less quickly over the last five years than it did between 2004 and 2009 or between 1999 and 2004. Average family premiums for workers in small firms (3- 199 workers) ($15,849) are significantly lower than average family premiums for workers in larger firms (200 or more workers) ($17,265).”

Please note that the average family premium has increased less since the ACA went into effect than in the decade prior.

As we discussed, premiums are high because healthcare costs are high. This, in turn, is forcing employers to pass on more of the cost of health insurance to employees through higher premiums, and try to keep costs down by offering plans with narrower networks and higher out-of-pocket costs.

Although I should also note that healthcare costs increased at their lowest rate in 2014 since 1960, when the government been tracking such costs (read about it here). This is attributed, in part, to the lingering effects of the recession, but also to structural changes resulting from the Affordable Care Act.

Providing health insurance to all Americans is increasing the federal debt.

Actually, the nonpartisan Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) reports that given the provisions in the bill, “the ACA’s overall effect would be to reduce federal deficits.” In addition, coverage provisions from the ACA (subsidies on the exchanges and cost of expanding Medicaid) have come in (and are expected to be) much lower than initially anticipated. About $104 billion lower between 2015 and 2024.

Health care in countries with single-payer systems (like the United Kingdom) is terrible and people have long waits to see specialists.

Nope. A 2013 Commonwealth Fund survey of people in 11 countries ranked the US next to last in terms of ability to get a same-day appointment with a primary care physician, although we did do better (ranked third) in our ability to see a specialist within four weeks. Other surveys find that the US ranks last on nearly every indicator of quality in health care, while spending more per capita than any other developed country.

I’m going to stop here because this is turning into quite a long letter and you’ve probably fallen asleep by now. I’ll close by saying that I respect your right to dislike the ACA and the government’s foray into health care. All I ask is that you back up your contentions with facts, not sound bites.

One more thing: If you don’t like the ACA, what is your suggestion to fix our broken healthcare system?



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