Healthcare Insurance History
Last 21 Days ACA Healthcare History
On September 7th and shortly after Pelosi and Schumer decided to be nonpartisan and help Republicans who still had an ounce of decency to pass hurricane Harvey aid and set a new National Debt Limit, I wrote about the inherent dangers of being so magnanimous. Lets face it, during the Obama 8 years, Republicans made it a vow even before he took office to oppose everything coming from the other side of the aisle even refusing to participate in committee meetings. The ACA passed by Democrat votes only.
The danger with being nonpartisan with Republicans and passing good things which are beneficial to the constituency is you allow Republicans afterwards to concentrate on issues which will not favor the constituency or Democrats. Passing hurricane aid and a new debt limit did allow Republicans to get back to the more partisan effort of defunding the ACA and more money for the already rich through tax reform. The two are interlinked. The repeal passes funding for tax reform.
Angry Bear wrote on September 7 about the danger inherent in helping Repubs, wrote again on September 13 about Republicans being confident on defunding the ACA and its impact, again on September 15 about trusting Trump and Republicans with a hand-shake-deal, and last week on September 21 when Kimmel called Cassidy out as a liar and Krugman, other columnists, and blogs finally woke up to the impending danger of the Graham – Cassidy Bill.
Angry Bear called it early in the month on Republican treachery to defund the ACA. The vote will be this week before the 30th. I do not trust McCain. Hopefully, I am wrong on McCain.
Older Healthcare Insurance History
I thought this comment by a blogger was interesting to read as we wait for the Senate to take up the Graham – Cassidy Healthcare Insurance Bill which will defund the ACA if passed this week. I wander the blogosphere and I run into some interesting people from time to time. This particular commenter had a wealth of knowledge on healthcare insurance going back a ways. I have captured the commenter’s words to present them to Angry Bear. Hope you enjoy them.
“When, early in our adventures in managed care, I was marketing for clients like Sisters of Providence, who were attempting to set up their own managed care, non-profit PPO (which ultimately they did not see to completion), in the late 1980s, health care insurance was still non profit.
At that time ‘commercial insurers’ did not refer to health insurers at all. Commercial insurers provided for-profit RISK insurance — which health ‘insurance’ isn’t (and can’t be without defeating its original purpose; to help more people afford care while helping providers maintain expensive facilities and services). Health insurance was created as an additional way, beyond taxes and charity, to socialize increasing health care costs — to assure the healthy, self-interestedly, that the resources to meet their inevitable health care needs would be there when needed. And to ensure hospitals would have a revenue stream to help them maintain the increasingly sophisticated and varied resources to meet the modern care needs of their communities.
Although the first actual, modern health insurance program is credited to a hospital in Texas in the 1920 which contracted with school district employees to provide services to for a monthly premium (it was non-profit); proto-insurance schemes based on the same principle — asking healthy EMPLOYED people to contribute a modest monthly amount to cover care if and when they were injured or ill — were used long before. The Sisters of Providence, for instance, established the first hospitals in my part of the world, the Pacific Northwest, in the middle of the 19th century, offered loggers care for their not-infrequent injuries for a payment of $1 a month (this I understand having cut down trees while gaffing up them). The connection between health insurance and employment did not, as many people believe, just arise as a government idea with favorable WWII tax policies. It arose from a much older recognition of the reality that injury and illness compromise patients’ ability to work, earn and pay — and the recognition the employed, especially those in the more commonly dangerous occupations, had both the income with which to make regular payments and an incentive to make arrangements to provide for themselves, as eventual patients, with care when needed despite the economic vulnerability illness caused — while providing providers with resources that helped maintain facilities and services and workforce to provide that care.
Until the advent of ‘managed care,’ which deregulated the health insurance market in ways giving insurers a greater ability to limit who was covered and what was covered — to their own benefit (but not necessarily to the benefit of our social need for broadly available health care, or increasingly, premium payers’ needs either). In fact, commercial insurers avoided the health insurance market like the plague.
It was understood by everyone that there was no way to make a profit in it While still meeting policy holders actual needs.
Health insurance was created solely as a way to socialize costs for health care consumers.
It did and does not and can not work like a car, flood, or even life insurance where insurers work out, and profit from, fairly reliable actuarial probabilities about what percentage of policy holders are likely to ever make a claim, the likely length of time the average policy holder will be paying premiums before making a claim, and from those probabilities charge — and deny coverage — accordingly. People, the overwhelming majority of policy holders, will depend on health care coverage again and again and again — for services large and small — with more and more needs, and more serious needs, accumulating over time.
Inviting commercial insurers into the market as we did in the late 70s and 1980s, with managed care, was a big mistake.
But many countries, Germany, Switzerland, France, provide excellent, cost-effective universal systems that are not single payer — they rely in different ways on a networks of non-profit and public insurance. Although some countries allow for-profit insurers who provide some limited extra coverage, they are very limited.
I don’t think we should throw their examples out while looking for the best way for the US to provide universal coverage.
Especially considering how many Americans do receive coverage through insurance at work, and are happy with that coverage, and our long history with that method of socialization.”
Add in this Sanders-Cassidy debate and we now a month long saga of incredibly stupid political moves by Dems.
Nothing good can come out of this debate, only bad. It now sets up a strawman for Rep Senators and their votes on this bill, “I cannot allow single payer to become the law of the land.”
“People, the overwhelming majority of policy holders, will depend on health care coverage again and again and again — for services large and small — with more and more needs,”
This is a bug, not a feature. You have (some) people going to doctors over and over for minor issues because they pay only a small portion of the cost. Then you have to add to this the admin costs and the insurer profits….well that adds up to one of the big problems with health care costs.
To use one of your comparisons, auto insurance….how much would premiums be if they covered oil changes, tune ups, tire changes, light bulbs, routine maintenance?
Number of Doctor Visits by country can be found here: Visits by patients by country. In the US, the number is 4 times per year as compared to 14 for Korea, 9 for Germany, 6 for France, etc. The US is near the bottom in doctor visits.
At the present time with th increase in deductibles and co-pays so as to have what conservatives and Congress call “skin-in-the-game,” people have limited the number of times they go to the doctor as the cost is too much and increases annually with the unregulated cost of the commercial healthcare industry. The problem still remains as to cost due to the commercial healthcare industry and not the patients going for care.
Sammy. I have a new Peugeot in France. All that you mention is covered for three years. It was included in the purchase price of the car for it seems to be €1200 for three years.
That is funny.
It is funny but sad.
I need someone to tell me how many times they have gone to the doctor when there was not a need. Maybe it is me, but every appointment is a pita.
The idea that people somehow like to go to the doctor is insane.
So in the late 1980’s health care was non-profit?
The 1980s was certainly before the privatization and consolidation wave for hospitals. At least in Massachusetts, and as far as I can tell in most of the rest of the country, most hospitals were built with public money or private donations and operated in most cases as not for profits.
That is no longer the case.
The manage care came about in the 70’s under Nixon I believe. It did not start to take hold until weil into the 80’s and full force the 90’s. HIPPA was part of that.
There has always been a move in this nation to “industrialize” and finacialize the health care industry. Namely making employees of the doctor. Managed care was the vehicle to do this.
I have read a few years ago that the Catholic church now owns 30% of our hospitals. Now, do you think they are doing this out of the good of their heart?
For the moment at least the Graham-Cassidy bill is dead … not coming to the floor for a vote, though they still have 24 hrs x 4 days less ~ 3.5 hrs (~ 92.5 hrs) to twist arms, break legs and pull it out again to pass it before Sept 30 expires at midnight. It won’t happen, but never say never.
You know of course that the entire GOP opposition to the ACA, its origination, and the various other promoted versions of gov’t funded health care since before Teddy promoted knowing full well it couldn’t happen anyway (thus nothing more than a political stunt) is and always has been about preventing another gov’t social insurance program.
Any reasonably knowledgeable conservative knows full well that once a liberal social concept actually gets in practice it’s going to make more voters happier than unhappier and so getting rid of it is impossible.
The ACA had enough time to get underway to make it more appreciated than not and so the GOP is now on the hook to do whatever it can pull off to defund or minimize federal funding to it.. letting it die by slow death over time seems to be their only chance to kill it over time.
The GOP knows and most everybody else on the planet knows that once it’s a benefit to people it will slowly become better & better with lower and lower costs and prices, increasingly a competitor to defense spending and tax cuts … actually they know the wealthy will eventually have to pay higher taxes for it, for-profit insurance and hospitals, and equipment mfg’ers, and drug companies will end up being less profitable and thus capital owners will have to find other things to invest in that are more profitable.
All this is simply to say the GOP is losing the laissez faire fight but not without doing everything in their power to make it last longer
It is part and parcel of the unspoken class warfare struggle … they know that unless they can kill the ACA or privatize it for more profits and less health care and do it soon, the struggle will become mute…. just as all of their efforts to maintain the status quo and turn back the clock do over time.
I mean it’s pretty simple: Think about eventually taking 1/3rd to 1/2 out of national health care spending — that’s a lot of profit gone for capital owners. The GOP will do almost anything in the short run and take the short-run hit to prevent the ACA from continuing and ultimately morphing to a better, lower cost and better care government funded and regulated system.
The ghost of Jefferson still looms large though.
Yes and killing the legacy of our first black president is a large part of the repeal the ACA fight… kill that and the black president won’t stand as tall in history, nor can stand against the perpetual belief by whites of the inferiority of non-whites. That in and of itself is a major problem going forward for the GOP to use racism as a crowd pleaser and vote getter.
So there’s a lot more in the long term riding on the GOP’s back with the ACA than just the currently proposed tax cuts.
And then of course there’s the present issue of a majority GOP controlled congress with a dumb-fuck GOP in the executive chair and still not being able to pass any substantive conservative wish-list legislation yet….with the mid-terms getting closer and closer.
They’ll come back to repealing or minimizing federal involvement in the ACA before the mid-terms to kick up their base support again.. it’s a political imperative for their base.
I find it extremely suspicious though that no matter what they try and how they try it they just can’t seem get the requisite votes though. To me it smacks of political charade to pull smoke over their base’s eyes … “we’re trying desperately”, with all the drama attached makes for a good show… Is this just random politics or is it a strategic script? .
As the author of the kindly (I think) posted comment, I would like to remind anyone who thinks health care could operate the same as car insurance if we just do whatever we can to discourage those who “over-use” the system of this irrefutable fact:
Mortality is universal.
And, as has been said by more brilliant others, we start dying as soon as we are born.
Insurers can’t, and don’t, improve their profit picture by discouraging and denying coverage to malingerers and hypochondriacs.
They do it by denying very costly but life-saving care to infants born with congenital defects; to workers suffering chronic illness and/or deadly crisis because of, in the course of doing work that our commercial enterprises absolutely depend on, decades of exposure to noxious chemicals, heavy metals, and even radiation; to mothers with high risk pregnancies that threaten their lives or the lives of their infants, or both. Etc. Etc.
If you, like the overwhelming majority of us, don’t run to the doctor with every sniffle or minor injury, that doesn’t do one thing to make health care less costly.
Or change the fact that the seriously ill and injured, the long term disabled, the failing elderly and dying, make a REALLY LOUSY consumer market.
You can’t support, can’t have, a sophisticated and effective system of care, that offers the very, very broad range of care any human community requires, and Americans expect, based in the out-of-pocket payments (or acceptance of long term debt obligations) of healthcare’s most important and “loyal” customer base. Which is how a genuinely “free market” system would work.
And that is true even if you tried to limit services to the teeny, tiny, ultra-rich market of people who could afford to pay the real cost. THAT market is simply too small to support the many and diverse resources and services needed. When use is off, fir instance, it does no good for the cardiac care unit to have a two-for-one sale.
So let’s stop preceding our system ever was, is, can be, or that any of the ways we want to manipulate it for greater profit have anything to do with, the “free market.”
Our system is socialized and always has been — like every other modern, sophisticated system in the world. The difference is we do so VERY inefficiently — because we are trying to pretend cost don’t have to be socialized and pretending we are encouraging “market solutions” by creating greater opportunity for profit-taking
Doing so has made mess. That we can’t even talk straight about.
Because we are lying to ourselves.
And none of this mess has a chance of being improved upon until we stop lying.
I am not speaking here as a bleeding heart. I’m speaking as as a business owner and a marketing professional with MANY decades of successful experience in the ‘free market.”
Welcome to AB. First comments always go to moderation to weed out the spammers and advertisers. You should also recognize “run75441.” Good to have you aboard.
Ditto to Schu…
Nicely said, but since we haven’t stopped lying to ourselves since at least the era of Teddy Roosevelt (and of course before that as well), then what well ever stop us from lying to ourselves?
The Trump election isn’t the first administration to vehemently oppose socialized health care and won’t be the last. The electorate has always been persuaded by the right wing “individualism”, “free-market”, “small gov’t”, “States Rights” proponents … e.g. capital owners, racists, and “god fearing” religious nuts, that socialized anything is tantamount to the devil incarnate and anti-American, if not communism, then leading to communism (a-la the USSR variety).
Even most people believe SS is “I earned it myself”.. thus not a socialized system.
In the Trump election, according to the raw data in the AB post related to the Economy, Trump voters put Health Care at #10 of 23 Issues which were “very important” to them, while Hillary voters placed Health Care at #1. In the wted composite (wted by proportion of Hillary and Trump voters) Health care came in #3 behind Economy and Jobsi n that order. More-over other poll question responses on health care issues show that the Trump voters don’t place high priority on anyhing related to gov’t doing health care, while Hillary voters do.
So the health care composite ranking being #3 is perhaps a misleading metric of “very important”, since conservatives’ “importance” lies in removing socialism from health care, while liberals want more socialism in it.
We had a very brief 2 year span of liberal control which passed the ACA with no support friom the right at all.
So how or when will we “stop lying to ourselves”? What will turn people who are “indvidualism’s” proponents into “socialism’s” proponents?
That is the question — not whether Sammy thinks health care should be run like the automobile private enterprise vehicle maintenance system. .
So the average number of doctor visits in the US is 4 times per year?
If health care is 20% of GDP ($18T x .2) = $3.6T. And the number of people in the US is 350M
then the average per person per year is $10, 285. Divided by 4 is $2,500 per visit. Wow.