The American Healthcare Conversation Continues

The country is once again involved in a tortured discussion about what many people call healthcare and how to provide it to the American people. But the discussion is not really about healthcare itself (the United States probably has the best in the world). The discussion is really about health insurance. Health insurance is a very complicated system designed to provide the money to enable patients to acquire the care they need. Health insurance was actually started during the depression by hospitals which wanted to be sure that they would get paid during times of economic downfall. It eventually morphed into a similar insurance system, as we know now, during World War II. It became employer-based because wages were frozen. Unions and other people decided the way to get more pay, in the form of benefits, was to create employer-based health insurance. That was the genesis of the system that we know today.

As the insurers gained more control over the payment system they also gained more control over what they can deliver. The system has become so complicated, involving all the worst mechanisms that you could think of, all of which would destroy any normal business. These mechanisms included, above all, micromanagement and the metamorphosis of insurance plans and the benefits as the insurance companies determine. Throw in the multiple benefits managers and pharmacy middlemen and you have a true economic morass.

The Affordable Care Act did have some benefits in that the pre-existing condition was eliminated and children were able to stay on their parents insurance until age of twenty-six. The Obama plan was quite stressed, however, by that it was to be funded by a group of young people who would pay a premium for healthcare that they probably would not use. The young people did not buy this insurance. Plans and premiums vary widely from state to state, making the insurance very unaffordable for many in the middle class. The conditions that Obamacare imposed on the patients, and the patients’ improper utilization of the insurance, coupled with micromanagement, led to the problems we see today.

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