Medicare is great, not perfect, but for the most part very well run. In my twenty years as a Health Care IT professional, in dealing with health care payers, I rarely have problems with them or with commercial insurances like Aetna, Cigna and US Healthcare among many others. In contrast Medicaid is a nightmare. Each time I have to call them, while I sit on hold, for usually a very long time, I feel like I am falling into an abyss of red tape. They are understaffed, underfunded and not taken very seriously. When I do get someone on the phone, they often contradict the last person I talked to there. It is my impression that they are saying whatever they need to get me off the phone. This is very frustrating when you are just trying to get the health care providers the money they have coming to them. It is a wonder that the poor's health care bills ever get paid.
One of the problems is that people confuse Medicaid with Medicare because their names are so similar. Medicaid used to be called Welfare, but it was rebranded because of the negative connotations that Welfare elicits. It is government assistance for the extreme poor among us. This is probably why they are a mess. America doesn't prioritize the poor very highly and the poor doesn't have strong lobbyists fighting for them like the elderly do.
Those who follow the numbers have noticed that our health care system is getting worst, from a financial standpoint for the last few decades. It is untenable and will crash eventually. My wife said to me recently, in frustration, "Our health insurance sucks!" My response was "Everyone's health insurance sucks now. That is the problem." Costs are spiraling and health care payers are struggling to stay afloat. This isn't new. We've known about this as a society for quite some time. A few brave politicians have tried to tackle it. President Richard Nixon did, but then came Watergate and survival became his priority. President Clinton tried but that was a complete failure, but he did pass HIPAA (Health Insurance Portability and Privacy Act) which was tremendous success at least from my viewpoint. Obama passed the ACA (Affordable Care Act aka Obamacare) and it was, by no means perfect, but it was a step in the right direction.
What HIPAA did for me, as an IT professional, is standardize things. Before HIPAA, insurance companies could demand you send them electronic files and/or paper for claims in any format they wanted. Each payer had a different requirement and the providers had to jump through hoops to get their money from them. After HIPAA, there are standards that everyone (payer, provider, government, commercial) have to follow. We have what are called 837 files for insurance claims. After they are approved, the payments come in 835 files. When there is a problem with one of these files, it is deemed HIPAA non-compliant and most of the time the errors you deal with are benign and common. Life is a lot easier now. This is why whenever I hear someone say that government isn't the answer to our health care woes, I reject it completely. Government can and does often make things better. Not perfect, but better.
How did our health care system get so bad? I blame Baylor University. I kid about this really. I've worked with people at Baylor and they are some of the nicest and capable people I've ever worked with. In the early 20th century, health care was not a big deal. Americans didn't spend a lot of money on it and only went to see a doctor until they were dying or very hurt. Baylor hospital had empty beds that they wanted to fill so they had an idea to offer a low cost payment plan that would allow people to come to the hospital for non-deathly matters. The first plan offered teachers 21 days of a hospital bed for $6 a year (equivalent to about $120.00 in today's cash). Other hospitals in the Dallas, Texas area came on board. Once the Great Depression hit, no one was going to the hospital because they didn't have the money even for cheap health care, so other hospitals came on board. This plan was called Blue Cross. In a short time, every state had a Blue Cross plan available. During World World II, President Roosevelt sign Executive Order 9250 as a means to control inflation. Wages were frozen. So employers found a way around this by offering benefits to attract hard to find employees. Health insurance being tied to your employment was born. When WW II ended, the American economy boomed with the rest of the industrialized world in tatters. Competition for good employees was high. By then, you could not compete without have an insurance plan for your employees. In 1943, the IRS deemed that health plans were tax exempt. This created a boom for anyone who wanted to start their own health insurance plan.
Nothing about this is set in stone. It is just an accident of history. This fee for service plan only drives up the cost of health care. Providers have financial incentive to provide more care in quantity, not quality. It has gotten to the point where the system is unsustainable. When the ACA was passed and your good plan was cancelled, it was going to be cancelled anyway. Insurance companies just timed the cancellation of these to coincide with the ACA's passing so they could scapegoat the government, rather than explain the hard realities to their customers. The American health care system is on the verge of collapse.
The 2018 mid-term election just took place on Tuesday this week. I am in amazement by two things: 1) Trump's ability to drive people to the polls. Both voters that hate him and love him, showed up in droves. We had the highest turn-out for a mid-term election in recent years. 2) Democrats were able to stay on message. It is not a simple thing, for a politician, particularly one leaning toward the left. I have never seen this before. They could have easily ran against Trump, but they didn't. They let him be his own worst enemy. They ran on health care. The Republicans tried to claim that they were the health care party but it is obvious to anyone paying attention that they are not. Many of them lied during their rallies and commercials that they supported protecting pre-existing conditions coverage. In regards to health care they had nothing to run on. They couldn't bring up their bullshit tax plan that no one other than billionaires liked. Americans are finally figuring out that something needs to be done with our health care woes and there is only one party that is doing anything.
Lets hope that the Democrats continue to stay on message and run this wave into the 2020 election. I don't know how to get to a Medicare For All. It seems to an insurmountable problem. But I know, the first thing we need is the political will. The Democrats will need your support to do this. Stay with them. Your life could depend on it.
