The Blind Men And The Elephant - 2026

 

 

 

No, I am not recycling titles.  This post is an update of sorts to the May 22, 2015 blog of the same name. 

Dan Crenshaw (R-TX) was on Bill Maher’s show last week.  Though he consistently supported the administration’s agenda and reliably parroted all of the talking points, he still failed to get President Trump’s endorsement.  He lost in the March primary.  Now, with eight months left, he COULD, COULD deviate from the script when discussing health care in general or Obamacare in particular.  Not Dan.  Never Dan. 

It has been eleven years since I wrote a blog detailing the ways an E/R doctor, a chiropractor, and a psychiatrist perceived the Patient Protection and Affordable Care Act.  Their impressions of the law, like mine, were informed by their personal experiences.  For providers, this often meant how much they were paid for the procedures and services they performed as well as how hard it was for them to get their money.  Agents see which clients can now have insurance (private or public) to help them access and pay for health care.  We also see people who once had health insurance but are now exiled from the market. 

I am reminded of the story of the blind men and the elephant. In the ancient Jain version, six blind men are asked to describe an elephant. They each feel a different part of the animal. Each is convinced that he, and he alone, understands the nature of the beast from his limited contact. 

I never pretend that I see the PPACA in its entirety.

One of my friends recently corrected me.  He noted that I often refer to Louisiana as G-d’s Waiting Room.  He insists that that is Florida, a legitimate retirement destination.  Louisiana, hardly a destination for anyone, actually had population declines for most of the last five years.  But I’m not focused on elderly pensioners in golf carts.  I am interested in access to health care, the quality of said care, and the roadblocks erected by the state, local, and congressional leaders from the state.  And that is why this blog has so often discussed Texas and Louisiana, two states that would be happy to impose their level of awfulness upon the entire country. 

My perspective comes from nearly fifty years in the insurance business.  I worked with small businesses and the self-employed through most of my career.  Policies effective prior to the start of the PPACA in January 2014 were subject to underwriting.  We asked lots of health questions, as well as your occupation, driving record, hobbies, travel plans, and even criminal history.  The wrong answer might result in a higher price (rating), an exclusion for the treatment of certain illnesses or hobbies (rider), or you could be declined.  I was forced to say “NO” more often than I liked.  And I spent a lot of time looking for backdoors into the system.  Agents fought the insurers for their clients.  I find it odd how few people remember that fight.

Agents also had another fight, one that often seemed even more difficult.  Though we had many employers who only wanted the best for their families and their employees, we also had our fair share of employer clients who needed to be convinced to adequately cover their employees.  I will never forget the doctor and his wife who told me, “I know that the contract says that I have to provide health insurance for my nanny, but it doesn’t say that it has to be good insurance.”  That was 30 years ago when deductibles were $100, $250, or $500 and they wanted a plan with a $10,000 deductible.  There were machine shop owners who wouldn’t bother to provide insurance that included the doctors seen by their foreign-born employees.  Those employees couldn’t or wouldn’t work elsewhere.  They were stuck.  Many of us viewed the employees, not just the employers, as our clients.  We expended a ridiculous amount of energy helping them access and pay for the health care they needed. 

When I see Texas, the state with the highest number of uninsureds, export the Ken Paxton lawsuit chaos designed to invalidate the PPACA or to eliminate preventive care, I think of those machine shop employees.  Texas is a large state.  Their congressional delegation has enough weight to impact the rest of us.  And Louisiana?  Becker’s Payer Issues has released a new report listing the best and worst states for Medicare.  Louisiana, the home to Mike Johnson, the Speaker of the House, and his Majority Leader Steve Scalise is ranked dead last.  Louisiana ranks near the bottom on most tables such as life expectancy (47^th).  And I keep thinking of that doctor, not the feckless Dr. Bill Cassidy (R-LA), no, the one who would cheat his underpaid nanny. 

I still see the Patient Protection and Affordable Care Act, even after all of the intentional harm inflicted on it over the last 15 years, as a step towards helping Americans access and pay for health care. 

We are all blind men standing around the elephant.  We will describe what we perceive.  And guys like Dan Crenshaw will always be positioned directly behind the beast. 

Dave 

Health Insurance Issues With Dave

Pictures – An Elephant? Really?

                 A Behind The Scenes Peek at Health Insurance Issues With Dave

            Both – David L Cunix