Death Panels by Default

I am not a big fan of Newsweek writer and reporter Kurt Eichenwald‏, but he turns up in my Twitter feed now and then. Today he posted this about Trump’s attempted destruction of the Affordable Care Act, which I think is worth sharing at its full length:

Next in my "How Trump Just Destroyed You" series. My wife is a doctor. let's talk pre-ACA. Two stories.

A trucker is working in his yard and falls out of tree. Badly hurts his back. Goes to my wife. In the course of their appointment, he brags about his cheap insurance. Will require a lot of work. Has four appointments.

At the fifth, he is told his insurance ran out. His policy covered four appointments, which is why it is cheap. He needs surgery: not covered. Hospitalization: Not covered. Rehab: not covered. Can't even see my wife or any internist anymore because they can’t take insurance AND provide free care. Must now go to free clinic. They can’t help.

He ends up in emergency room. YOU pay for it. They patch him up, send him on his way. Problem not gone. Can't drive truck anymore with back problem. Sells home for surgery. Can't get rehab. Still can't drive. Goes on unemployment. YOU pay for it.

ACA kicks in, with minimum coverage standards. He signs up for policy. Can’t get rejected for preexisting condition. Gets full hospitalization etc. coverage. So gets treatment. Is now a trucker again. Was a rock-ribbed Republican. Now understands the lies they tell.

Second story: ACA didn't kick in soon enough. Had cheap policy. Got cancer. In the middle of his chemo treatment, hit the coverage cap. Ranted and raved. "Why am I paying for coverage if it doesn't cover me when I'm sick?" Welcome to GOP health care, pal. Chemo cut off. He dies while ACA is being debated because the cancer has spread throughout his body.

THIS is the real world. THESE are the death panels.

Unfortunately people in this country have a horrible combination of treating politics like it's about "my team," MASS ignorance and MASS arrogance. They think they are experts on insurance when Sean Hannity says something. And now they will die. Or lose everything. But hey! At least now they can go back to buying cheap insurance that lets them shell out $ for premiums year after year for fake coverage, thanks to Donald “I don’t understand anything” Trump.

Oh, and don’t think you can now rush onto a good policy when you need it. Sorry folks, because policies without minimum standards will divert stupid people in good health, the risk pool for preexisting condition folks will shift to high-risk, and premiums will explode. And the more people who try to rush back from cheap policies to real policies when they get sick, the higher the premiums will go. WAY past unaffordable. Because the insurers will be making their money collecting from stupid healthy people.

The private market is dead. Make America Die Again. And again, if these cheap policies are SO GREAT, then every member of Congress and the Trump admin should save taxpayers $ and be forced onto them. Yah, right. They want to live. They don't give a damn whether or not you do.

Whether Trump will be able to implement his “plan” or not (given lawsuits and possibly… Congress?), Eichenwald is clearly right about the types of things that used to happen before the ACA, and as much as I don’t like some of the ACA’s realities (the trend toward high deductibles, especially, and the idea of “skin in the game”) it’s clearly better than where we used to be, as shown in Eichenwald's two anecdotes.

Eichenwald's examples were echoed by a letter writer in today's Star Tribune, Michael Emerson of Eden Prairie:

Like many Americans, I lost my job in the fall of 2008. Our first option for family health care was a COBRA plan that cost $2,000 a month for a family of five. Or, we could find much cheaper health insurance on the open private market. That seemed quite promising. While these plans were cheap, they offered very minimal coverage. But one big problem. One of our children had taken a medication that precluded our eligibility for these plans. They were cherry-pickers. They only took individuals and families who had perfect risk profiles. That made the COBRA plan the only option that we had.

So that is what Trump is creating. A market for those who have no risk factors and a second and wildly unaffordable market for everyone else. Anyone between 50 and 65 will be slammed by this order.

The cruel fact is that Emerson could easily be paying $2,000 a month (or more) for an individual/family ACA silver plan in 2017 (that's almost what my family of three is paying now, as I've said before). But at least it covers what it should cover, has yearly and lifetime caps, and averts the scenarios described by Eichenwald, unlike Trump’s “plan.”

This stuff, as Trump finally realized after he became president, is complicated. Listen to people who understand it, like Andy Slavitt and Atul Gawande. Make it better, not worse. Figure it out.