Choice Goes Begging

The realities of Obamacare bring to light the failure of our health insurance and health delivery systems, systems built on government rules rather than patient needs. This reality predates, and is only made more oppressive due to, Obamacare.

One of the big deals about Obamacare is that individual health insurance policies must be “guaranteed issue” meaning that that coverage cannot be denied due to pre-existing conditions. The other big deal about Obamacare is that every individual not covered by an employer plan is supposed to be forced to buy coverage or pay a tax (they call it a “Shared Responsibility Payment”). When you combine these two key attributes you are supposed get everyone in the game so, while everyone shares in the cost of everyone’s medical problems, the risk pool is very large and the costs therefore spread across almost all healthy and sick people.

Nice concept. Lousy reality.

Little discussed is the more important reality that no one in America has market driven choice of health insurance and delivery. Government mandates across the spectrum of health care insurance and delivery limit choice of products and procedures, and also disincentivize doctors and other medical professionals.

This post has the numbers. The realities are:

  • You are stuck with your employer’s plan, which may be very good for you but you better check the plans of a potential new employer before you change jobs. Further, many employers may drop coverages under Obamacare, forcing you into an individual “Marketplace” policy.
  • You are stuck with an Obamacare “Marketplace” policy. Use of the term “Marketplace” is something out of a George Orwell novel. There is no marketplace. There are just paper pushers selling one set of government approved coverages and requirements with add-ons that cost even more.
  • You qualify for Medicaid. You get what the government tells you are are going to get and you must go to doctors and medical facilities the government tells you to use.
  • You are 65 or older and qualify for Medicare. The government forces you to take Medicare under penalty of a rising premium for every month you qualify that you don’t enroll. Another interesting twist to Medicare Advantage and Supplement plans is that they are (with few exceptions) only “guaranteed issue” during the initial six month enrollment period beginning when you are about to turn 65. After that, you may be denied the right to coverage if you want to change your Medicare Advantage or Supplement plan or insurance provider. As a practical matter for most people, you are stuck with the Medicare choice you make when you turn 65, for the rest of your life.

Contrast the realities above with other consumer driven market based insurance products such as auto, life, home, and liability coverages. We must ask why health care is treated with such an over bearing government presence both before and after Obamacare.

You need to ask the question, “Why don’t I have any choice in the matter?”

Regards, Pete Weldon

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