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


How Many Sharks Can the #GOP Jump Before the Party’s Over?

Boehner ObamaJosh Gerstein’s piece, “5 questions about John Boehner’s lawsuit against Barack Obama,” in Politico is a frank and candid examination of the pros and cons, both short- and long-term, to both sides in the GOP House lawsuit against the president.

At this point, I consider the lawsuit to be an idiotic and colossal waste of time and taxpayer money. We need to understand that Obama’s executive actions to delay enforcement of certain PPACA provisions are supported by precedent and are good for businesses.

Anyone else ready to admit to not recalling that in 2006 W unilaterally decided not to penalize seniors for missing a deadline to sign up for prescription drug coverage under Medicare? Would anyone go on record as wanting to sue him for that?

Here’s the more delicious bit of irony in all of this.

Businesses and the people who own and run them – the segment of America that the GOP is always claiming to be on the side of – would be the ones to suffer if the delayed Employer Shared Responsibility (ESR) rules were being enforced on the timelines originally written into the law.
(For a quick primer on the ESR, see

The only question left for me is how many times the GOP has to jump the shark before anyone except white senior citizens constitute what Gallup recently described as the GOP’s “strongest age group?”

Is it any wonder that when thinking of the future of the GOP I’m reminded of the days when Don Meredith would sing to us on Monday nights?

Jesse Ventura on ‘Obamacare’: Health care is a human right, rips apart the GOP

See on Scoop.itDidYouCheckFirst

Over 10 million Americans now have access to affordable health care by either the private marketplace or through an expansion of Medicaid because of the Afforda

Greg Russak‘s insight:

Jesse, were you of these opinions before you went off the grid? I’m impressed. 🙂

See on

Number of HIX Enrollees Who Paid First Premium in Dispute

See on Scoop.itDidYouCheckFirst

How many individuals and families that selected a health plan in the federally facilitated health insurance marketplace have paid their first month s premium? Depends on whom you ask.

Greg Russak‘s insight:

No, it does not depend on whom you ask.


Can we just call this "dispute" what it is? It’s partisan propaganda, and it’s one-sided propaganda.


Asking the GOP anything about the Patient Protection and Affordable Care Act at this point is pointless, isn’t it? What do we expect to hear from the same group of legislatures who have wasted countless hours and our tax dollars voting to repeal this law how many times now?


They simply have lost all credibility, and they did it to themselves. 


On the question of premium payments, the PPACA changed absolutely NOTHING about how insurers bill for and collect premiums. It’s still the same accounting. Whether or not customers of private insurers have paid their first (or any) premiums isn’t governed by the PPACA. Invoices sent and premiums collected are STILL a private matter controlled by the carriers and dependent on lots of issues, not the least of which include did the carriers actually send a bill yet to their new customers and what’s the grace period? 

See on

As ACA Signups Skyrocket Towards 7 Million Fox News Claims Obama Is Cooking the Books

See on Scoop.itDidYouCheckFirst

As the number of people who are enrolling in the ACA’s private insurance plans surges towards 7 million, Republican Sen. John Barrasso and Fox News Sunday teamed up to claim that President Obama is cooking the books.

Greg Russak‘s insight:

If you’re still listening to and believing anything from the GOP and Fox about the Patient Protection and Affordable Care Act, you need to understand that, generally speaking, you’re hearing spin and outright lies.


Barrasso trots out the same tired and debunked lie that the PPACA is limiting choices and even excluding what doctors and hospitals are available for us to go to. That’s bullshit. Complete and total bullshit.


What the PPACA did, among other things, was to set minimum standards for health insurance. Those standards are called Essential Health Benefits. It essentially makes junk insurance a thing of the past.


As for what insurance is available on the exchanges in each state, make no mistake about this point. Offering insurance is a decision made by the insurance companies. Their decision to offer their products in each state is a market-based decision, and their products are regulated by each state’s Department of Insurance.


If you live in a state where there’s only one or two choices, and those choices now have higher premiums and less coverage, you must understand that that is the free market at work. PPACA only sets minimum coverage standards. With the exception of protecting seniors from getting gouged, it does not set rates and it does not dictate what policies are offered to you.


I’ve done a fair amount of research into the PPACA. I currently work for a service provider to the insurance industry. For anyone who’s interested, here are a few blog posts.


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


Americans Stick With Obamacare As Opposition Burns Bright


The Case for #SinglePayer


More #PPACA Red Herrings: Renewals and Benefits


The Fault, Dear Citizen, Is Not With ObamaCare


See on