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.




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

“California’s Real Death Panels”–Data Reveals California’s Private Insurers Deny 21% of Claims

“The insurance companies aren’t in business to provide care; they’re in business to make profits for their shareholders. One of the ways in which they make profits, the main way they make profits, is by collecting money from patients and from families and not paying money back in claims. They call it a medical loss ratio, every time they make a payment on a claim.”
Charles Idelson, Communications Director for the California Nurses Association/National Nurses Organizing Committee.

Wendell Potter, whom you may recall from a previous email, is the former p.r. head at CIGNA also appears in this story.

So does a mother, Hilda Sarkisyan, who lost her daughter who needed a liver transplant but whose insurance company, CIGNA, reversed their decision to deny the claim too late and only after public outrage was raised.

If you bother to read or listen or watch this and still think that the status quo – a market-based health insurance industry without a public option – can be trusted to do what is morally right and humane; if you think that it’s best for America that every single fellow American cannot get health care because they all aren’t insured and can’t get it or have their coverage dropped or denied, then I have to ask you if you are simply in denial about the realities of health care in this country, or are you just resisting change over petty partisan politics?

I actually hope it’s one of those two because the only alternatives I can come up with are much less palatable. One other possible explanation that occurs to me seems to be that money must be more important than human life.

Those campaigning against change seem to be simply lying about the notion that if people who don’t have health care suddenly have some means of getting it means it can only come from something that is taken away from those who do have it need to hear one word; Ridiculous.

Something else about all of this debate troubles me. Whatever happened to being a Christian nation and taking care of one another? Is the guiding religious principle really just “cafeteria Christianity”, allowing people to decide which teachings to accept and which to ignore? Whatever happened to the “least of my brothers” teaching? I’m not at all qualified to comment on Christian dogma, but I don’t recall anything from Catechism classes about any qualifications or fine print that went along with that lesson.

Or is the real religion – especially among conservatives, it seems to me – really about worshiping wealth and the aspirations for wealth and the acceptance that stepping on whomever’s neck it takes to get to whatever your own definition of prosperity might be perfectly fine?

I mean, what other possible reasoning and rationale can their be for not putting private insurance companies on notice? What other reasons are there for resisting change and everything that doesn’t have a certain political party’s stamp on it?

Only in America, it seems, does greed and lust for wealth take precedence over proper medical care for every citizen and the humane treatment of fellow human beings.

Only in America would the same people who want to bring the Christian Bible into the public schoolroom while they overturn a woman’s right to choose using arguments about protecting the unborn life be the same people who place more meaning on shareholder wealth than they do on the life of someone who needs health care and can’t afford it. (While they tend, it seems to me, to ironically also be the biggest supporters the death penalty.)

Only in America would the argument against a public option be based on an unfounded fear that those who have health insurance might somehow lose what they have if the less fortunate among us were to now have it.

Sorry, but I see all of this as just being greedy and hypocritical. In fact, I think it’s totally and completely reprehensible. It makes my blood boil that some of us in this country continue to choose to vilify the poor and less fortunate because, as we all know, they are just a bunch of lazy, good-for-nothing slackers who want to sponge off the rest of us and don’t deserve any help, including affordable health care.

Let them die in the streets or in over-crowded and under-funded emergency rooms, right? Let’s keep turning a blind eye to patient dumping? Let’s not do anything to stop health care bills from bankrupting good old fashioned middle class American families?

Let’s let kids who need transplants die?

And please don’t tell me that you think it’s the illegal alien who’ll benefit from health care reform or that your new hero is that uncivilized and juvenile buffoon, Joe Wilson. I think the GOP can kiss another Congressional seat goodbye in South Carolina.

I don’t mind telling you that I’m about this far away from being one of those Americans who has to go without any health care coverage. I’m out of work and can’t afford a grand a month to pay for health insurance much longer. I’m not looking for pity or sympathy, just making it real for those too far on the right-of-center on this one.

What confounds me about the GOP and makes their position so completely unbelievable is their resistance to changing the system. The financial services industry proved that they cannot be trusted, and it seems painfully obvious that the health insurance industry cannot, either. More of the same is simply more wrong, and the Rs really have become the party of No on this issue. They seem to have had too little interest in compromising on anything when they were in power, and now the chickens have come home to roost.