HEALTH CARE/Joan Retsinas

Needed: A Stake to Kill the Vampire-Myths

Even those who voted for Donald Trump recognize that he offers no great new ideas, just a re-hash of discredited ones. The President, elected with populist enthusiasm, is a garden variety mogul, reaching out to other bigwigs, all giddily eager to repeal the last decade of government activism. The flurry of “antis” has rolled forth: this President has appointed officials who loathe the regulatory bodies they head. Woody Allen might pen a comedy around this rollout; we the viewers (and victims) are not laughing.

On the health front, we see some tired myths crop up. No matter how much data we lob at them, we can’t kill them. Call them Vampire-Myths – they live on, revived in this Administration.

Myth One: Health insurance is a commodity, akin to cars and houses. The marketplace should offer a range of choices, from none to simple to comprehensive; you should choose what you can afford, what you want. Not everybody needs to drive a Mercedes. Only those wealthy enough (the sub-text is that they are smarter, more productive than the bus-riders) should buy one. Similarly, why should everybody have a comprehensive health policy?

The answer: illness is random, and devastating. Do we allow the non-insured person to lose a leg to gangrene? To let a woman die of untreated breast cancer? Or make a man with a painful arthritic hip forego hip replacement? A host of diseases have effective treatments; but a minimalist insurance policy translates into minimalist treatment; and no policy – the choice in a country that has repealed the Affordable Care Act - generally translates into no treatment.

Myth Two: Mandates are un-American. Please: for the good of the community we all pay Social Security taxes; for the good of the body politick, we should all pay to maintain the population’s health. Besides, we are saving people who refuse insurance – their American right to be free – from their own idiocy when a malady happens. Diabetes, mental illness, cystic fibrosis, arthritis, accidents, cancer, et al. beset people regardless of political bent.

Crucially, an insurance pool spreads risk: eliminating healthy enrollees, the ones who don’t “need” insurance, drives up premiums. Besides, those healthy twenty-somethings will eventually age into the diseases of their parents and grandparents.

Myth Three: Insurers should be free from government shackles – specifically, the pre-existing condition exclusion. Insurers understand profits: spend less on care than you reap in premiums. One way to minimize payout is to enroll healthy enrollees. How better to beef up the health of a pool than to refuse to treat the maladies of your new enrollees? If an enrollee has diabetes, the insurer will pay to treat a broken leg – not a new pancreas. The absurdity of this exclusion spurred Congress to restrict it in HIPPA; the Affordable Care Act killed it. Restoring it will restore insurers’ solvency, but destroy the lives of many enrollees.

Myth Four: Letting people buy insurance across state lines will unleash millions of new enrollees into the insurance pools. Admittedly, every state puts its own restrictions on policies, though the large employers that self-insure, as most do, leap-frog over state rules. Yet this old idea presumes that policies in one state will be markedly cheaper, without being markedly worse, than policies in another state. So would-be enrollees would shop for insurance on the web as they shop for home equity loans. The reality is more complex. Before the Affordable Care Act, state policies did lead to a range of premiums, in part because each state has a different population mix (that pool again), as well as health care costs. Also, each state varied in its “mandated” benefits; e.g., treatment for substance abuse, infertility, chiropractic care. The Affordable Care Act, however, instituted “essential benefits,” thereby reducing much of the disparity in state costs. ( In a post-repeal world, states could revert to their own mishmash of policies; but nobody expects this would help the millions of people unable to afford insurance without government subsidies.

Myth Five: Government can institute safety-net “high risk pools” to save insurers from the risks attendant on “high-risk” patients. States tried this: not surprisingly, the premiums in high-risk pools are astronomical. A pool by definition shares risk; including only the very sick in a pool defeats the purpose. Indeed, the Affordable Act required insurers to accept all applicants – thereby getting rid of the need for high-risk pools.

Congress can repeal the Affordable Care Act. After all, the members of Congress, as well as their families and workforce, enjoy government-subsidized health insurance. Repeal won’t hurt them. It will hurt the millions of Americans who depend upon the safeguards built into this Act.

Let’s put a stake through these myths.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, February 1, 2017

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