The election is over and Obamacare is here, perhaps to stay or perhaps to be amended. And with what appear to be some serious issues concerning implementation. By 2014, state exchanges were to be set up so that those without health insurance could purchase the minimum essential coverage. There are currently a large number of states that have not established their exchanges. The reasons?
The governors of those states do not want to use state funds to establish and run exchanges that are mandated by the federal government.
The states would not have much input on how the program would be operated.
A large portion of the regulations establishing the exchanges have not yet been written.
When Obamacare was signed into law, our legislators did not consider that the states might not be excited about following federal guidelines that excluded unique state conditions. This one size fits all concept of the federal government does not take into account the differences that might occur as a result of different demographics. A state with an older population has different health issues from a state with a younger population. Providing adequate health care means paying attention to those differences.
Adequate health care presumes a number of things. First of all, that there are enough doctors and hospitals to treat those who are sick or accident victims. Secondly, that the decision makers for health care have a background in medicine and alternative treatment methods. In recent weeks, there have been massive layoffs in the medical industry. Some hospitals have closed. If they didn’t close, they laid off many workers. By reviewing the daily announcements, you are able to extrapolate the numbers related to the field of medicine.
Then there are the various panels that seek to control health care costs. These are not doctors. And it appears neither are they bioethicists. Some examples where this is an important issue are:
Avastin had been approved to be used in cases of metasticized breast cancer. Approval was revoked in November of 2011. It was said that the length of extra time it gave patients was not worth the cost. The cost? $1,000 or more per injection.
Patients who are in a persistent vegetative state are not expected to recover. One hospital tried to withhold food and water stating that care for these patients was futile. It now appears that perhaps as many as 40% of these patients have been misdiagnosed. Continuing brain scans on these patients may show us that there is a chance of recovery as brain cells start to come back. And for these patients, it may be paralysis that is affecting their inability to communicate and not the condition of their brain.
Lack of adequate care seems to affect the poor more than other groups of people. Obamacare does not address this problem. It is the hospitals and doctors available to the poor that are closing their facilities at a more rapid pace.
And then there is the cost for health insurance. Prior to the mandate, insurance companies used actuarial tables to compute the cost of claims. Then this information was used to calculate the amont of revenue needed to satisfy the claims. Usually, the groups of people were separated into five year age ranges. Now new rules are being announced. First of all, rates cannot be established for age ranges. They must be developed for each age. And, the cost for the older people being insured cannot be more than three times the amount the youngest person is being charged.
Common sense should indicate that the older a person becomes, the more likely they will be vulnerable to disease and deterioration. After all, they had a lifetime of bad habits to reach that point. So for an insurance company to obey the law and not bankrupt themselves, they will have to raise the cost of insurance for the younger policyholders. This could mean paying 50% per year more while older policyholders will find their rates reducing by about 13%. Is this fair? No one expects the federal government to be fair.
Perhaps next time we should require our legislators to read the bills before they pass them. And if there is some question concerning how it will work, get the answers first. There is probably very little chance that this administration will make any significant changes to the provisions. When you add in the things not covered automatically under the minimum essential coverage, you have the possibility of our country’s health care system beginning to resemble that of a third world country.
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