The difference between healthcare and health insurance explained (mostly for Republicans and Trump’s acolytes)

People like GA Republican Rep “Buddy” Carter and the rest of the GOP are either misleading Americans or out-and-out lying to them.

They either don’t know the difference or are intentionally obfuscating the difference between healthcare and health insurance *choices* by either unwittingly or knowingly talking about them as if they are one and the same, and that Americans are somehow being held back from making choices because of the Patient Protection and Affordable Care Act.

 

The only people who won’t have choices and who will be left behind by the GOP are people who aren’t covered by employer-subsidized health insurance and who aren’t poor enough to be covered by Medicaid. The so-called “free market” cannot solve this issue of access to healthcare in an affordable way for EVERY SINGLE AMERICAN.

It’s a Business – That’s the Problem

Health insurance as a business exists solely because healthcare has become too expensive to be a service one can pay for out-of-pocket.

Doctors stopped accepting chickens decades ago, and a 1.2trillion dollar industry – the insurance industry, that is, of which 55% is in the life/health side of the business – has absolutely nothing to gain and everything to lose as a business by actually insuring people who need healthcare.

Why does healthcare cost so much? Lots of reasons, I think, but mostly for two reasons.

Capitalism at its Worst

The first is because we’re all just greedy enough and selfish enough in capitalist America to actually put a price tag on healthcare and on life itself.

As every good capitalist would tend to agree, the more expensive something is, the better it must be (or at least many of us have convinced ourselves of that premise).

So, if healthcare costs a lot and some people are priced out of it, c’est la vie. That’s capitalism and free markets at work, right? (“Yeah! Tell those lazy poor people to get a job!”….and all of that dysfunctional and inhumane nonsense we hear all the time from libertarians and conservatives.)

The second reason healthcare is so expensive is one that many may not realize. It’s *how* it’s paid for in America.

30% of the cost of delivering healthcare in America is tied up in “administration.” That’s a euphemism for processing claims; claims that are paid by insurers whose profit motive is to take in billions in premiums and to not pay or to pay claims as slowly as possible.

Make no mistake about it. Private health insurance companies are the real death panels.

Compounding the problem of administrative overhead costs is that every health insurer has a different way to process claims. It’s why 1 in 4 people who work in healthcare work in administration.

In 2015 there were 859 health insurance companies in the the U.S. Even if all you count are the top 25, that’s still 25 ways a healthcare provider will have to know how to process claims if they want to be paid. That, or they turn away patients who have health insurance they don’t know how to process, or they outsource claims processing to a third party. Whatever decisions they make, it all adds up.

Single payer eliminates it all.

You Had 8 Years and Trumpcare is the Best You Can Do?

As for the embarrassment that is the GOP abomination presumably 8 years in the making, “choice” is among the many lies “Buddy” Carter and the rest of the GOP are trying to sell you on now.

I worked for a company that provided technology to insurance carriers. Not agents, the insurance companies themselves. I saw it from the inside. Here’s how the industry works in a nutshell.

Insurance companies come up with products – the plans they want to sell. They have to file the products with each state’s Department of Insurance where they wish to sell said product(s). Each state decides independently as to whether they allow said product to be sold to their citizens.

One of the many Protections in the Patient Protection and Affordable Care Act that insurers did NOT like (they only liked the mandate) was the elimination of junk insurance. It’s called that because that’s what it is.

Junk insurance were plans like the one I had to have a few years back when I was laid off, couldn’t afford COBRA coverage, and didn’t want to risk being “tagged” as uninsured by a future employer and their insurance company. I went to the open market in those pre-Obamacare days.

The plan I found and that I could afford was UnitedHealthOne Saver 70. It was $275.00 per month. It had a $12,500.00 deductible, paid only 70% after that was reached, and didn’t cover office visits or prescriptions.

That’s the kind of “choice” the GOP and insurance companies want back. A cheap plan that for all practical purposes guarantees the insurer will never have to pay benefits on because the insured will never go to the doctor because that’s another out-of-pocket expense, and they can’t afford the 12-grand anyway before benefits would kick in.

If Ryan and the GOP get their way with Trumpcare’s threat of a 30% buy-back-in penalty, junk insurance will fit the bill perfectly. It will make millions off of poorer Americans who will never file a claim but who will buy junk as a hedge against that future buy-back penalty.

Insurers Put Profits Over People. Period.

The insurers who are whining and crying and gnashing their teeth as they abandoned the Obamacare health insurance exchanges in some states didn’t abandon their health insurances business (although it must be understood that some insurance companies were so greedy they did stop selling health insurance because of the PPACA’s 80/20 rule).

The insurers who have left state exchanges did so because they couldn’t make enough money in those places and from people who were previously uninsured but who are now able to get healthcare for which the insurance company must pay.

Which brings us back to Rep Carter. He’s either an idiot or a liar or both.

I take that back. What he is is a Republican politician.

In my view, the sooner Americans come to their senses and stop voting for Republicans at every level of government, including the state and local levels, the better off we all will be, and the sooner we’re likely to move to a healthcare system that serves us better and which every American can benefit from regardless of their income.

 

Sources

INSURANCE INDUSTRY AT A GLANCE

The Reason Health Care Is So Expensive: Insurance Companies

Top Health Insurance Companies

Administrative costs are killing U.S. healthcare

Rate Review & the 80/20 Rule

 

Blogs I’ve written in the past on the topic of health insurance

More #PPACA Red Herrings: Renewals and Benefits

The ‘Protection’ in the Patient Protection and Affordable Care Act

Health insurance companies keep making the case for single payer

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#It’sOnUsAll

I found this article and the embedded video to be quite moving.
omran-daqneesh
How can we do this to each other?
What can we do to stop it and to change it once and for all?
The answers I keep coming back to start with abandoning the mythologies of religion. Whatever good comes from them is attainable without the dogma that’s been used to kill millions over the centuries and which continues to the present.
The second thing I think we need to do is to change the way we think about capitalism. It needs to function with a conscience. I’m convinced that it can if we consumers demand as much.
The third is to consciously work as individuals and as a society at being more compassionate, more empathetic, and more accepting of people who aren’t exactly like us.
It’s never too late to do any of these. I still believe in humanity, and in our ability to live peacefully even when our societies and cultures are different.
What I do think is that we adults need to do a much better job of not just teaching our children these lessons, but we need to be much, much better at actually living them in front of children.
Outwardly showing contempt and hatred for people – even for children – for their religion, their skin color, their sexual preferences and gender identities, or their ethnic and cultural heritage needs to stop.
Hatred is learned. We all know that. What I think we all need to do is to accept the responsibility that we’re all teachers to every child on this planet. They learn by watching and listening to us adults, and they don’t miss anything.

Republican voters: You have more in common with #Sanders than you probably want to admit

Are you in an income category that will see a tax increase under Sanders’ proposals?

How many people do you know personally who would have their taxes raised?

Sanders Income Tax Plan

The question of which income group can and should be paying more, both in real dollars and percentage of their incomes, for all of society’s benefits is the wealthy.

Why them? Because the wealthy in America are actually the greatest socialists to ever live, and no amount of failed Republican rhetoric about trickle-down economics or the amoral lies of libertarian Objectivism will change this reality.

Only voting for people like Sanders will.

Corporatism is Capitalist Socialism

Think about it.

Everything that happens in the present-day and so-called capitalist system we live in is designed to not just “trickle up” but to flood the wealthy with greater and greater advantage and wealth.

Besides Wall Street’s insane ability to privatize all their gains while socializing their losses; besides polluters who can freely pump greenhouse gases into the atmosphere without bearing any of the expense for what the pollution does; besides the hundreds of billions that are spent annually from federal coffers on subsidies and contracts to some of the biggest and richest corporations ever seen on the planet; the everyday occurrences that also make them socialists include all of the benefits they get from a system that is set up to actually make their wealth even possible.

  • Publicly funded infrastructure
  • Local services like police, fire, emergency medical services, snow removal, garbage collection, public libraries, etc., etc.
  • Public schools and universities
  • Social service programs that their workers – sadly, more and more of our fellow citizens – need just to survive, forget about growing and thriving

How does this happen?

Because too many Americans have been duped into believing they are Republicans and insist on voting against themselves and the rest of us by voting mostly for corporatist Republicans who pass ALEC-written laws that benefit the already rich and powerful.

You’re Not a Temporarily Embarrassed Millionaire, You’re a Socialist

The rich and powerful have had it too good for too long and at our expense.

It’s about time we all wised up and started electing people like Sanders who will tilt the field back in our favor.

Not to a level field. Tilted to our favor.

The “level playing field” where one’s lot in life is supposedly determined solely by their desire and tenacity and hard work is a ridiculous and juvenile Objectivist myth perpetrated by libertarians who love to believe that Americans are not socialists by nature but actually just “temporarily embarrassed millionaires.”

I call out libertarianism in particular because, generally speaking, it is an especially abhorrent and selfish form of corporatism which happens to form the foundation of modern-day Republican social and economic policy.

True believers will try to deny their history. History won’t let them, and neither will I.

History shows without question that what rich and powerful men – and with still rare exceptions in the 21st century, it’s white men of privilege – left unchecked will operate with wanton disregard for anything resembling what it means to be a human being living in a modern and civil society. They are sociopaths, and why some people outside of their gated communities and exclusive country clubs would decide to worship them for their cutthroat Objectivism and for their hoarding of wealth and power is one of today’s great social and political mysteries.

Far Past the Time to Raise Taxes on the Rich

The rich and powerful exist only as a result of our labor. If the economy was limited to only the transactions and consumption of the richest 1%, how long could it actually last?

Spend the next few minutes listening to venture capitalist, Nick Hanauer, if you don’t believe me, or Sanders, or Robert Reich, or anyone who understands even the simplest concepts of how our economy works.

The rich and powerful rule over us untouched only because too many of you in the 99-percent insist on voting for Republicans which is, at the very least, a vote against your own economic self-interests and the economic interests of all of the rest of us.

That’s why I’m supporting Bernie Sanders.

For the first time in my 50+ years, I feel like there’s someone I can vote for who is willing to talk about raising taxes on the rich and who is willing to say to all of us that,

The issue of wealth and income inequality is the great moral issue of our time, it is the great economic issue of our time, and it is the great political issue of our time.”

So, I get it. It’s easy to understand why you’d be a libertarian or a Republican and against Sanders if you make (or inherited!) a lot of money.

What’s impossible to understand is why you’d consider yourself to be a libertarian or a Republican if you don’t have a lot of money.

Trapped by the Kochtopus

It’s important to be aware of and to avoid being trapped in the tentacles of the Kochtopus and their libertarian empire.

If you’ve never heard of the Kochtopus, then please spend some time making a close examination of the tentacles of Kochtopus so you’ll understand just how far-reaching a single wealthy family like the Kochs are influencing everything around you; from the media, to think tanks, to academia, to legislators and judges, and more. If anyone can find a similar beast that exists on the left, I’d like to see it. (Cue the George Soros haters.)

Wake Up Call

Look. It’s time for everyone making $250K or less to wake up and to stop pretending you’re a temporarily embarrassed millionaire, or a Republican, or even a libertarian.

You’re not, and you likely never will be.

If you make less than the $400K+, which is what it takes to be a One-percenter, and you still call yourself a libertarian or a Republican, then you’ve been duped.

You may not realize, but what you actually are is a corporatist. You’re on the wrong side. You’re supporting people like the Koch brothers, the Waltons, and Wall Streeters who wouldn’t cross the street to piss on you if you were on fire. (Crass, I know, but I think it makes the point, don’t you?)

What you are is one of us.

You’re a 99-percenter.

And, you are far more likely to benefit from a tax increase on the wealthy to fund policies and programs that tilt the field in favor of middle class and poor Americans than you are to find yourself among the whiny One-Percenter “socialists” who will just have to find a way to go on living with one less house in the Hamptons and one less yacht to water ski behind.

Come on. Just be real. Five minutes at Sanders’ campaign site will convince you that you have way more in common with the vision and policies of Bernie Sanders than any other candidate. (To my fellow progressives, liberals, and Democrats, that includes Hillary, too, btw.)

We are all democratic socialists. We all should be supporting Sanders. We should be caucusing for him and voting for him in the primaries. He’s the only one who seems to care about all of us outside the One-Percenters, and that’s ok. The One-Percenters will be fine no matter what. It’s all of the rest of us that we should be thinking about now.

What Costco has to teach the 99-percenters who think they’re Republicans

It’s not complicated. Every retailer, restaurant, and corporation in America can do what Costco is doing, but they don’t.

Costco

Why is that?

I think it’s because the people who own and run these businesses refuse to look beyond next quarter’s financial statements. Their thought processes, their vision, and their values don’t include ways to share their wealth with their workers.

They are greedy, selfish, sons-of-bitches who want us to think that’s just how capitalism works.

That also seems to be how today’s conservatives who are outside the 1% think, too. What other explanation can there be for why they think they are Republicans?

Conservatives Don’t Seem to Understand Reality

Costco clearly has leaders, a board of directors, and shareholders who are visionary and courageous enough to implement ethical and moral business strategies that are profitable AND which include a more equitable distribution of those profits to workers in the form of livable wages.

Contrast that with the lies we’re told by Wall Street, by Big Business shills like the U.S. Chamber of Commerce, the National Restaurant Association and the National Federation of Independent Business, by libertarian mythologists like Heritage Foundation and Cato Institute, and by Republican politicians who keep claiming that trickle-down economics works, that we should abolish a minimum wage and leave compensation to market forces, and that government interference and over-reach are stifling business and our economy.

How is it that conservatives don’t get that all of that is, of course, complete and total bullshit?

How is it that conservatives who make less than $340,000.00 – what it takes to be in the 1% – insist on voting for Republicans and their failed policies which have ALWAYS been designed to benefit the rich and powerful first and foremost?

Liberals: Time to “Welcome Their Hatred”

We need leaders like Bernie Sanders who welcome the hatred of Wall Street and Big Money.

Compare Bernie

 

We need people like Lawrence Lessig as politicians who represent us and who are willing and eager to confront Big Money for their lies and their failures.

 

As individuals, we also must welcome the hatred of the rich and powerful. We need to find the courage to band together. We need to shine light on the fact that conservatism and Republican policy is to blame for where we are now as a nation and as a society.

More than anything, we liberals need to stop surrendering to the all-too-common liberal weakness of always wanting to find compromise.

No more compromises. It’s how we got to this sorry state of affairs. We let conservatives move the center further and further to the right by acquiescing to their demands and our own desire to avoid confrontation and conflict.

No more.

Liberals didn’t elect Reagan and two Bushes. Liberals didn’t cause banks to fail. Liberals didn’t demand that government shrink and corporations become less and less regulated. Liberals didn’t funnel all of the recovery and wealth to only the absolute richest among us.

We liberals need to continue to point out these and all the inconvenient truths that stem from conservatism (and its absurdly juvenile and greed-driven stepbrother, libetarianism).

Our fellow citizens who self-identify as conservatives need to hear from us whether they want to or not. They need to hear the truth; that they are also part of the ever-shrinking middle class and the ever-growing class of working poor.

They need to hear from us liberals that they are wrong – plain and dead wrong – for voting for ANY Republican anywhere and at any level of government.

They need to keep hearing it. Conservative (and much of libertarian) ideology that informs and drives Republican policies have unequivocally been proven to be dead wrong for everyone on every issue, and that includes economic issues. That is true, of course, for everyone except for the rich and powerful.

The Parties Are NOT The Same

It’s pretty simple and absolutely obvious. The GOP is the party of big business and the rich.

For those who are tempted to trot out the b.s. false equivalence that, “Both parties are the same,” save it. As far as I’m concerned, you’re second in line as the greatest obstacle to making real progress in this country. You give Republicans cover, and you need to stop it.

Number one on the list of obstacles are actually those Americans living in households with adjusted gross incomes of less than $340,000.00 per year who insist that they are Republicans and who vote for Republicans. I have news for them. They are not in the 1%. The conservatives in the 99% mean precisely nothing to Republicans except as useful fools who can be counted on to vote for them.

Organized Labor Is the Path to Prosperity

It’s absolutely stunning that conservatives aren’t banding together with the rest of us in the middle class in support of organized labor. History proves that stronger unions are the path to better and higher standards of living for everyone.

It bears repeating.

If you make less than 340-grand and think unions are somehow the problem and Republicans are the answer, then you not only don’t understand reality, you’re the biggest obstacle to prosperity we have right now in America.

So, how about it, conservatives?

How about you wake up and stop voting against yourselves and the rest of us?

You’ll thank yourself and, more importantly, so will future generations.

95 percent

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Additional Reading:

Strengthen Unions

Wealth Inequality in America

Top 1 percent: How much do they earn?

Capital Eye Opener, March 8: The Fight Over Minimum Wage, and Rand’s Partisan Appeal

New Poll Shows Overwhelming Support for Major Minimum Wage Increase

Activists Around the US Fight to Raise the Minimum Wage