Obamacare and the Federal Exchanges vs. Local and Community Based Health Care

After years of argument, the Affordable Care Act (aka Obamacare) which was clumsily shoved through Congress in 2010 is out in a form which consumers can review it and judge for themselves if they truly are getting more care for less. For the 14 years before my husband took a day job with employer-provided insurance, my family and I veered between having no insurance and having crappy Healthnet insurance with an extremely high-deductible and a claims department which seemed to believe nothing has risen in price since 1975, often leaving us to negotiate with our medical care provider’s accounting department about how much of the remaining amount we had to pay. Eventually, I realized it was far cheaper to not use our insurance for anything routine (like a physical and a pap smear) at all, and simply negotiate as a cash payer.

And as a cash payer, I also saw that we (at least in Santa Clara County, California) already had a good tax-payer subsidized system, backed up by charitable free or sliding-fee clinics. So I’ve always been puzzled and confused by fellow Americans screaming that they will die if the government doesn’t take over our health care system. After going back and forth for months on the payment for my daughter’s six-month vaccinations, I learned that our county vaccinated children under the age of 12 for free; and provided vaccinations for teens and adults for a nominal fee. They ran a Healthy Families program which allowed middle class families with school-age children to have preventative-care-focused health insurance, regardless of pre-existing conditions, and run like a non-profit organization. And when a friend was recently putting off getting his beta blocker prescription renewed, because a visit to his regular doctor for doing just that would set him back $200, I directed him to my favorite sliding-free clinic, the Indian Health Center. They had him fill out a lot of forms but in the end he got his prescription, plus a full physical and blood work for $42.

But as a result of Obamacare, the Federal government ordered the states to expand their Medi-Cal system, regardless of what they had going beforehand. As a result, Healthy Families is going away, and reportedly the state’s revamping allows some children to go on Medi-Cal, but not their parents. So now some California parents will have two separate bureaucracies to navigate when it comes to covering their medical costs.

Like many Californians, I took a look at California’s insurance exchange. It suspect it’s probably one of the better ones, since I was easily able to get on, and quickly get a quote for what is available and what I would pay based on my income. Their Shop & Compare tools let you figure out what you can get, and for how much, or if you qualify for Medi-Cal. I was shocked how much this “more affordable” health insurance costs . For our family of 4, all of whom are healthy and active, the cheapest (bronze) plan had a $5000 deductible and would cost us $1000/month. Our crappy Healthnet plan had that high of a deductible, but it only cost us $450/month and I thought that was expensive. If we lose employer-provided health insurance, we’re obviously better off paying the annual fine/tax for not having health insurance and paying providers directly on a cash-negotiated basis. If I suddenly keel over with a heart attack, we can negotiate the payment on that, too, and if it’s high enough, I’ll probably qualify for Medi-Cal.

I also recently found out that Christian healthcare sharing programs also qualify for an exemption from Obamacare’s mandate to buy health insurances. I didn’t know such a thing existed in this day and age, but it sounds like the way people used to protect themselves from being financially ruined by medical crises. In short a community (in this case, devout Christians where previously this might also have been Elks Club members or a union), regularly put money into a pool which will cover some costs, but members generally take care of their own inexpensive routine office visits. When someone has a medical emergency or surgery or some other large cost, the community essentially “passes the hat” to pitch in for the cost, on the assumption that if they were to experience a similar crisis, the other members of the community would do the same. It’s less expensive than insurance, and it presumably also would encourage members to negotiate the cost of a procedure. I don’t have the spiritual requirements to join such a healthcare sharing program, but then, I’m not being required to join them.

There’s several clear flaws no politician cared to think about or address as they rushed to scribble together a law to socialize much of our healthcare system.

The first is that most people still don’t know what any medical procedure costs, or what it should cost; they simply care about whether their insurance pays it. As a result, no one shops around to figure out who provides the best service for the best price. I did so, and we specifically picked our dentists based on how much they cost and how well they could explain their costs to us. If there’s any confusion, I can ask for a procedure’s “code” and ask for the price for that, and then you find out the doctors and dentists who bitch the most about how “cheap” they are are usually the most overpriced, and sometimes inept as well.

The second is that if think you can’t afford the care you need, for heaven’s sake, pick up the phone and call someone. Social workers — whose salary you also fund via your taxes — are a font of all sorts of resources, both public and private, which will help you, regardless of your situation. If you can’t get through to one of them, contact a religious organization of almost any denomination, though Catholic Charities and the Salvation Army are the largest, and they’ll direct you somewhere if they can’t help you directly.

And thirdly, in a country as large as ours, it’s often more efficient to let states and communities take care of their own. California health care costs are much higher than that in other states, and it’s because we subsidize so many others. But that is a choice per our own leaders whom we voted in, and because of it, we also have subsidized clinics and care for us when we want it. Should every state have to follow our example; can they not have different restrictions and guidelines appropriate to their demographics and communities? As it is, even in our generous state of California, Obamacare is messing with a system which was doing fine helping lower- and middle-class families, and giving them less options and higher costs.

And fourth, why is our health insurance system, which is really a profit-producing cost-sharing program, a core component of Obamacare? The process of pushing claims through an insurance company for approval and review is the most unwieldly part of our system, and now it’s required (unless you pay a fine/tax or qualify for Medi-Cal). I used to be a proponent of a single-payer system like they have in Europe, but I think our country is too big and diverse for it to work; plus I’ve learned to like being able to shop and pick between dentists and doctors. Why not think small, instead of always thinking bigger? Having just heard of healthcost sharing communities, they sound like a great option which cut the insurance company and the government out of the picture. Simply due its nature, the members are incentivized to take care of one another, to stay healthy due to peer pressure, and to network with one another and negotiate health care costs to get the best value. That’s something no government program can do, and it’s much less expensive that trying to fix a botched web site.

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