THE WONDERS OF HEALTHCARE IN AMERICA

There are approximately 324 million people residing in the United States.  According to the official Obamacare page 11.4% presently have no healthcare coverage. They claim that this is the lowest its been in 50 years, but what do the current plans under Obamacare offer that makes it worth signing up for insurance.  Let’s outweigh the pros and the cons.

I can only speak for South Florida because that is where I live. 

For those who are not offered health insurance through their employer, and can’t afford a traditional plan because of limited income, and costs of living, their only options are Obamacare or the payment of a penalty once tax season comes around. In South Florida some of the popular and more affordable plans have been offered through Molina, Preferred, and Ambetter, just to name some.  Of these currently two are no longer taking any more new enrollees.  I’ve come across family, friends, and strangers who constantly complain about the issues that they are having with this mandatory insurance.  What follows are some examples of the different issues I’ve been told about:

a.   When you sign up, you have to provide an “average” of how much you “expect” to make the following year because that is how they figure what you have to pay monthly.  So the average person states the same number they made the previous year which is fair, and expected.  They are then quoted a monthly amount. 

I’ll use the example of one of my family members who had this happen to him.  He was quoted around $150.00 monthly.  Obviously this plan comes with a high deductible despite it being one of the better plans afforded by this company.  During the year he had the opportunity to work overtime, which he took advantage of in order to make more money to support his family.  He also got lucky and was given a raise. It was not a significant amount, but a raise nonetheless.  By the time tax season rolled around he went to prepare his taxes and was informed that since he made more money than what he had approximated, he now owed the government over $1,500.00.  He contacted the woman who sold him the plan to ask about this, and to notify her that he would have much rather been uninsured, since he is quite healthy, and did not visit any doctors during the year because the fine would have been $675.00 not the over $3,000.00 that it ended up costing him.  Her response was that she could get him a lower plan with an extremely high deductible, and that if he fell ill he could call her on his way to the hospital and she would change it up so he would have better coverage.  Yes, she actually offered this.  Whether she can make good on it or not, it was offered.

b.  Another individual that I know, who does not make a lot of money, signed up for Obamacare and based on his earnings he was paying roughly $45 per month.  He had just undergone open heart surgery and would be needing constant follow up care.  During the following year his plan went up about $100.00.  Obviously he had to continue to pay because of his health condition.  The year after the plan dropped him saying they weren’t renewing memberships, and the only plan he was able to obtain charges him over $300 per month, which he can’t afford.

c.  Yet another incident involved a married couple who have Obamacare.  Both require monthly visits due to ongoing medical issues that need monitoring.  They signed up with a plan, and a  few months later they were informed that they could no longer be on this plan, no money was returned to them.  The wife called the Marketplace and was told that she could go under a new plan.  It was the beginning of the month and her payments are made on the 15^th of every month.  She was told that she could still go to the doctor that was assigned to her.  She asked for an appointment and stood outside his office for two hours in the sun with her husband and then close to another two hours inside to see the doctor.  She even took pictures of the ridiculous line and showed them to me. Right before they were to go in to see the doctor, she was advised that they he would not see them because she had not paid for the current month.  She explained that she pays the 15^th of the month, and she was paid up until then.  The doctor did not care.  He turned her, and her husband away.  She then called the Marketplace again and was told that she could go back and be seen that they had cleared it with the doctor.  She called the doctor’s office again for an appointment, who again reaffirmed that until she paid for the current month he could not see them.  Needless to say, she had to wait until after the 15^th of the month, when she made her monthly payment to ask for an appointment before the 30^th of the month so that the doctor could see them.  So it appears from what transpired, that they are only insured from the 15^th to the 30^th of the month because from the 1^st to the 15^th all bets are off.

d.  A close friend of mine who is married and both he and his wife are insured under the Obamacare plan had an issue when his wife started having abdominal pains and went to one of the hospitals on the plan.  There she was told that she needed to make an appointment with her physician to have him check her out and refer her for a CT scan.  She explained that she was in pain and could not wait for an appointment.  They said they were very sorry, but that is what she had to do if she wanted the plan to cover any part of it, if not, she could pay for it out of pocket to the tune of $600.00 just for the scan.  She ended up buying a round trip ticket to Colombia that evening, and receiving emergency treatment over there which required a few days of hospitalization, as well as all the prescription medication she needed to take care of her problem upon her return.  The ticket to Colombia was less than the cost of the deductible, and the $600 scan.  The medical care in Colombia cost her $1 for her co-payment, because she is insured and pays a minimal monthly amount to maintain health insurance in Colombia.

One of my personal experiences with how the healthcare system is out of control happened a few years back.  I suffer from psoriasis, as does my mother.  I was given a pharmaceutical sample by a friend of a new medication.   I gave some to my mother and it was actually very good.  She asked her doctor for a prescription since it worked considerably better than what she had been using.   She took the prescription to be filled and was told that the deductible would be $800.00.  Unfortunately, she could not afford this medication since she is a retired, Medicare recipient.  A few month later I traveled to Spain, and took a sample and the prescription with me.  There I walked into a drug store and was able to purchase the same medication for €55 (Euros), which at the time was about $70.00 USD.  I purchased two, one for my mother and one for myself.  

We hear the democratic candidates and some of the Republicans singing the praises of Obamacare, but the sad reality is that from what I have seen, it appears to be a scam designed to continue to line the pockets of the insurance companies, who are not accountable in any way.  They also have the benefit of high deductibles so unless you are chronically ill, and live in a hospital, you will not benefit from having the plan.  Other than not getting fined for not being able to afford it at the end of the year, the benefits are minimal for the average citizen, for the insurance companies it’s a win/win because with high deductibles, they don’t have to pay, but they get your money every month. 

What we see here in South Florida is that one company comes in, signs up everyone, takes their money in advance and a couple of months later they terminate the contract.  The “insured” has to then find a replacement company, who nine times out of ten provides significantly less services at a higher rate that they can barely afford, with even higher deductibles. 

In a recent debate, Trump indicated that he would open up state lines so all the companies could compete nationally, and this would drive the prices down.  I don’t believe this to be accurate, it would only expand the scam and make it even more difficult to document. Thus benefitting even more insurance carriers, and leaving the average American once again screwed.   Bernie also wants everyone to have healthcare for free, but that means a minimum of an 8% rise in taxes every year, and what does “free” really mean. 

It is interesting how the government imposes what they feel the public needs in a manner that only benefits the insurance companies and pharmaceuticals. 

Why don’t they start where the problems originate?  Why don’t they limit the prices that can be charged on medication?  Why don’t they have a flat plan that everyone can afford with zero deductibles and low co-payments?  Why don’t they oversee what hospitals charge on a regular basis for things like slippers?   I saw an itemized bill not that long ago for a patient who had entered the hospital by ambulance and died in the ER. On the hospital bill there was a $13.00 charge for slippers.  This was absurd since she was horizontal during her entire visit.  Unfortunately, they are not held accountable for the abuses.  If they really want to “help” the average American citizen who can barely afford to live on their menial salary as it is, much less pay for mandatory health coverage, which offers minimal or no coverage at all why don’t they do what needs to be done?   

If insurance companies and pharmaceuticals can afford to bombard us through the media with constant advertising, they can afford to bring down the prices of the medications they provide.  I will be the first to step up and say that I will sacrifice not being able to see yet another advertising for some medication with a laundry list of how it may end up killing me before it saves me, for the sake of lower medical costs for fellow Americans in need.  The only problem with this is that nobody does anything because it is even worse than going up against the NRA, and then, who would contribute to political campaigns.  Perhaps the problem is even more entrenched in the gut of American politics than what we can even imagine.  We all know that big business is always going to control government, but in the past years it is more obvious than ever which side our political candidates constantly lean towards. I would really like to see just one politician or President stand up and really do something for the health and welfare of the country, and not just talk the talk.