What does college tuition, car insurance, Spotify, Starbucks, and the Supreme Court have to do with your upcoming surgery?
Hear me out …
Something had to be done. That is a fact.
And I’ve always credited Barack Obama with at least addressing the problem, where all other politicians before him had not.
The problem? Pre-existing conditions.
Prior to the Affordable Care Act, if you tried to buy a private health insurance policy, but had some pre-existing condition (like asthma, heart disease or diabetes), you would not be able to purchase that policy. It was that simple.
You were in a high risk group and insurance is essentially betting. Nobody bets on bad odds. That’s what insurance companies do. They bet on the odds.
But not being able to purchase a health insurance policy could be a life-or-death proposition for you, in a worst-case scenario. Even a best-case scenario it might ruin your life.
My family DID have that very scenario.
When we were childless, young and healthy, my wife and I had this health insurance policy that only cost around $170 a month. To be honest, we didn’t really even use it all that much. We only went to the doctor about once a year. We trained like athletes and never got sick. We just kept it for emergencies.
Sometimes I would even forget I had insurance and just pay for a doctor visit out my own pocket.
I never thought about health insurance or medical costs at all. I never thought much about that monthly bill. It was just “insurance” (in-case-something-happens protection). And it wasn’t enough money to quibble over.
But then we brought our (adopted) daughter home from China and we started needing to go to doctors…a lot. Then, hospitals…a lot. And we filed the claims with that company we’d been paying into (and not using) for years.
But they started denying the claims.
See, there was this little loophole, we’d never read in our policy, regarding adopted children. If we adopted a child ONE DAY after their birth, they were subject to being screened first before being covered. If we had adopted our child THE DAY she was born, she would’ve automatically been covered.
She was 8 months old when we adopted her. The math is simple. And she was denied coverage.
Shortly after that revelation, we received an 87-thousand-dollar medical bill in the mail, for a dozen ambulance rides and as many E.R visits. And our lives changed forever.
The next years were spent trying to get my daughter some sort of medical coverage. I jumped through every hoop imaginable, getting a reluctant college education in the healthcare and insurance industries, in America.
I even took my case to the insurance commissioner of Tennessee. His exact words to me? “I’m sorry sir, but you’re screwed.” That’s a direct quote.
My daughter has a rare genetic disorder that often requires state-of-the-art treatment. We cannot self-insure. Well, not anymore, at least. Not since streaming services essentially put me out of business.
See, I was a highly paid songwriter with an extensive catalog earning money. It had taken years to build that body of work. And I thought when I needed it the most, I’d be able to take some time off, tend to my daughter and rely on the royalties I had worked my ass off to acquire.
But pirating and streaming services came along and decimated my profession. Why songwriting in particular? Was it the big, bad capitalist monsters that had stolen from me?
Well, I suppose you could make that case. But the real problem with my profession is that the government regulates ALL songwriting royalty rates. It always has.
The government stepped in to help all the poor songwriters struggling to make a living, in 1909. And a hundred and eleven years later, we’re still tangled in the constraints of their “help.”
This is an important piece to remember. It will make sense later.
When we found out we couldn’t purchase private insurance for our daughter, my wife took a part-time job at Starbucks to get us on a group plan. And that covered our daughter. But when my wife could no longer do the job, because of back issues, we were back at square one.
She took another job, that covered our daughter. But that company went out of business.
The saga that we walked through would take thousands and thousands of words to explain. Well, 65 thousand to be exact. I wrote a whole book about this in 2010.
But during the epic journey, we spoke with sitting senators and congressmen. We took her off all insurance for three months, to get her on the state’s S-CHIP program. But then they decided to close the window on the program exactly 90 days after we took that leap.
We actually spent a couple of weeks talking to federal lawyers trying to interpret whether the law meant “90 days” or “three months.” See, we were ONE day off on the timeline. And her getting on the program depended on the interpretation of that law.
We bounced around to every imaginable health care situation you can think of. And my daughter kept getting dropped from plans – then added onto plans. This happened 7 times. In every instance, the insurer that dropped her, then the insurer that picked her back up were both Blue Cross/ Blue Shield. All 7 times.
But then, in 2010, a new law was being debated: The Affordable Care Act.
My family was coming off a huge song and a great story and a book and we still had a little profile. And it was suggested to us, form some well-connected people, that maybe we would be the perfect poster family for getting this new law passed.
We asked to read it first. It was 2700 pages long. That’s twice as long as War and Peace.
We got to page 16-A and couldn’t make heads nor tails of any of it. When my manager asked for a clarification on some self-employment concerns, he was told he was listening to too much Rush Limbaugh.
We didn’t then, and don’t now, have any idea what that means.
Through our odyssey, I kept asking simple questions like, “why can’t I just shop for health insurance in another state, like I can car insurance?” or “Why don’t they just make my out-of-pocket medical expenses a dollar-for-dollar write off? or “Why can’t they incentivize doctors to do more pro-bono work with tax breaks for doing so?”
Little questions like this nagged at me and I couldn’t get an answer.
I started thinking about ideas that could’ve possibly fixed our nation’s problem. I brought them up once to my state senator. He thought they were great ideas but said they’d never get passed.
Here’s the thing: the only issues we had regarding healthcare, in this country, prior to The Affordable Care Act, was covering people with pre-existing conditions and tempering healthcare costs themselves.
How do you temper costs? Competition.
But why do doctors have to charge so much for their services? They usually have so much college debt that it takes decades to pay it off. I’m not sure you can address the hard costs of healthcare until you address the hard costs of college.
But what if we could buy health insurance anywhere in the nation, like we do can car insurance? More companies would spring up to get in that business because it would be a national pool of money they could access.
And with state-run monopolies having to actually compete for the consumer’s dollar, they would have to go to hospitals and doctors and negotiate down the prices of services.
Right now, if I get a kidney stone surgery (I’ve had 6), and I pay out of pocket, it’s exactly HALF of what it is if I turn it into my insurance company. That means even with his six-figure student loan debt, the doctor is game to negotiate. It’s the bureaucracy that’s in the way.
If I had the money to pay for that service out-of-pocket, but knew I could get a dollar-for-dollar tax write off for it? I would do it in a heartbeat. That’s how costs come down. It’s also how services get sleeker and quicker.
If there was a healthcare market where actual negotiating took place, instead of so much paper being pushed around to mitigate risk, the real, actual costs of things might find some equilibrium.
It seems like this is something we should at least try first. Doesn’t it?
During the Obamacare debate, I was told my daughter would be covered. I was told if I liked my doctor I could keep him. I was told my premiums would go down dramatically. And I was told that my Republican representatives didn’t have an alternative healthcare plan.
In fact, President Obama asserted that there wasn’t ONE SINGLE Republican healthcare plan.
None of those three things ended up being true.
My daughter lost her health insurance – well, what I should say is the new company that employed my wife went out of business because they couldn’t comply with the new law. And that meant my daughter got dropped…again.
We lost our doctor.
And our premiums skyrocketed.
And there wasn’t ONE Republican alternative plan…there were 11.
I read two of them. I still have Marsha Blackburn’s plan on my laptop. It addresses all my concerns and is only 27 pages long.
It could be implemented in a week. And it just might work.
The best plan I read was written by a senator from Indiana. A guy named Mike Pence.
Anyway …
When I called the government hotline on October 1st, 2014 (the day the ACA went into full effect), to find out about the exchanges, the computers were down and I was told I would have to submit my questions in a letter…through the U.S. Postal service. In 2014. That sort of summed up the efficiency and cutting-edge nature of the unwieldy law.
Fast forward past more years of jumping through stupid hoops and red tape, to today.
My daughter and son are both “at risk” people, so they both finally got approved to be on the S-CHIP program through our state.
My wife and I still have to get insurance through her work. And it’s very expensive.
Basically, all that happened was where we (the two adults) used to get insured easily, and our kids were expensive, now our kids get insurance easily and OURS is expensive. And guess who runs the insurance for ALL of our plans?
Blue Cross/Blue Shield.
A lot of people are frightened about the ACA getting overturned in the Supreme Court, now that the court has essentially been flipped philosophically. But the law never really worked the way they thought it would.
And most of it is just plain confusing, with so much of it being interpreted by the director of HHS.
There’s a rising chorus of people who want a nationalization of healthcare. And I get it. It sounds simple, streamline and humane.
But here’s the thing…
Once we go there, we cannot go back.
And something like that, in the third largest country on earth, would be a bureaucratic nightmare. The only two other nations this size who have tried Universal health care are there U.S.S.R and The People’s Republic of China.
You can read about the U.S.S.R in history books. And I got my daughter out of the China system once. We’re not in a hurry to go back.
ONE buyer would have control over the entire industry. No market forces at play. No negotiations of any kind…except those done in secret.
As someone who has watched the government, in all its well-meaning glory, preside over the absolute destruction of my industry, not because it doesn’t want to help, but because it’s not in my business and can’t possibly know what’s best for it, I shudder to think what would happen if it were in control of the business of saving lives and preserving health.
At the moment, we’re in the weird middle-ground of the government controlling just enough of healthcare to make it maddening.
If it were up to me, I would abolish the entire ACA and start all over again, knowing we HAVE to make sure we address the crack in the system people like my daughter fell through time and time again.
But I believe we can do it.
We just need a little creativity and imagination.
And maybe less paper.
R
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Regie's Blog 
Another great blog.
Healthcare in this country seems to be a problem no one can solve.
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Thank you for writing Regie. I hope you and your kids are doing well and staying safe.
Fact check, no one is talking about nationalizing healthcare. The UK has national healthcare, it means all the doctors have to be directly employed by the government. OTOH, the US already has Medicare, which is single payer health insurance, and it works a good sight better than the crap we have for people younger than 65. The proposal is to take something that is working, Medicare, and let everyone have it instead of just some people. At minimum we need a public option for Medicare, which would allow folks to be insured independent of their employer, etc.
I have been curious for years (ie, since i started lurking on this blog) about the songwriter compensation problem – how much of this would have been fixed if the original legislation anchored the (nominal) amount paid to inflation, so that it retained the same buying power over time?
Not all, I guess that totally misses the problem of unanticipated media (streaming/web-based), so let’s add in that the legislation shouldn’t refer to specific technology mechanisms like “radio broadcast” or something, it should instead have referred to ‘3rd party delivery of the content’ or something, matching the wording from the fine print copyright warning on all our home videos/DVDs about how you aren’t allowed to display to anyone other than your own household. Does not that fix the problems?
And what was the original problem being addressed in 1909? I kind of figure it was that the copyright claims against unlicensed radio broadcast of particular songs were effectively unenforceable because it was totally decentralized, so the fed had to step in and guarantee *some* songwriter revenue at all. Isn’t that… pretty much exactly the problem that you had with the streaming services, or at least wouldn’t you have had that problem with streaming services, equally as bad as what you actually faced, if there weren’t any federal legislation at all?
My concern about crossing state lines is that it creates a race=to-the=bottom on government protections, doesn’t it? As in, just like all the credit card and financial services companies are incorporated out of DE (or similar) because that way they face basically no limitation on how badly they can screw people over, so would all the health insurance find a gov’t protection desert from which to middle-man all our health care money away while denying all the substantive claims, etc.
For all the apparent similarity to car insurance, ie being an insurance, I suspect health care is really pretty different from driving:
a) end-user difference: Is Optional – if you prioritize arranging your life around not having a car, then you can’t have a problem with car insurance, vs. everyone gets sick sometimes;
b) end-user difference: Locus of Control – you have a lot more control of your driving outcomes than your health outcomes, especially in that the maximum possible expense for someone who does the right thing is pretty low – basically just a new car right? – vs in healthcare you can make all the right choices and still get basically an unquantifiable and infinite medical expense;
c) Market Structure difference – auto insurance basically doesn’t have transaction costs to operate in a new region, do they? vs health insurance faces major inherent barriers / overheads to expanding region of operation, they have to make contracts with multiple individual medical care providers.
The original ACA bill had a public option that got jettisoned because no Republican senator was willing to even negotiate in good faith on the bill, giving absurd leverage to most marginal members of the Democrat coalition in the senate. Which I bring up because public option seems to have that national baseline and guarantee competition in each market. Did you support that provision? Do you support it now as a compromise between the absurd status quo and Medicare For All?
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I understand…My son’s daughter has autism…The insurance is very expensive:(
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