He Doesn't Give A Damn

I was lamenting Friday night’s court decision in Texas. Across from me was a doctor, a really smart guy, who was not displeased. Upon prodding he finally agreed that many people, perhaps millions of Americans, might have reason to be concerned, but not him. After all, his side, the politicians whom he has aligned himself with due to both financial and philosophical reasons, had won. He could intellectualize the entire health care debate, but he didn’t see statistics much less people. Like most doctors in Greater Cleveland, he works for a system. The system handles all the dirty tasks of billing and collection and organizing the access to care. He just provides health care to whoever ends up in front of him. He just does his job. I don’t know if the system beat the empathy out of him or if he ever had any. I’m guessing he can turn his empathy on and off and thinks of people like us as leaky faucets. The struggle to preserve the access and payment for health care continues. My conversation with this doctor convinced me that he isn’t on our team, and that’s a shame. Like I said, he’s a really smart guy and we’re going to need all of the help we can get.

Healthcare.gov, the access point for millions of Americans to purchase individual health insurance coverage, was forced to send out announcements that the Marketplace was still open today, the last day of Open Enrollment. Forced. After two years of sabotage by President Trump and his administration, there was real fear that the portal would be closed immediately. Their site has a banner stating “Court’s decision does not affect this season’s open enrollment.” I received my first client email moments after the decision hit the news. Clients called the office to inquire about their status. They needed to be reassured that nothing has changed, yet. Welcome to America 2018 where governing by cynicism has given way to governing by fear.

This blog chronicled the run-up to the passage of Obamacare, the Patient Protection and Affordable Care Act. There were more than enough disappointments, pork-barrel politics, and short cuts to fill these posts and tick off my Democratic friends. And we have now had eight cynical years of the politics of repeal. (No links. Most of the last eight years have dealt specifically with this BS.) As long as we’ve had divided government the Republicans have had the luxury of whipping up their base, collecting large campaign donations, and the safety of impotence. It was a game that they thought, like Risk, would go on forever. But they won in 2016 and now have to govern and their actions have consequences.

What is at stake? What are some of the key consumer elements of Obamacare?

• Guaranteed Issue
• Preexisting Conditions are covered
• No Health Screening – no penalty for previous illnesses or injuries
• MEDICAID EXPANSION – coverage extended to the working poor
• Tax Credit Subsidies – ongoing premium assistance that facilitates the purchase of coverage
• Cost Sharing Reduction – a reduction in the deductibles and out-of-pocket expenses
• Essential Health Benefits – compliant policies are comprehensive
• No Maximum Benefit – elimination of the annual and lifetime limits

If you repeal the law without an alternative you eliminate all of the above and more. And what Republican alternative is waiting in the wings. It took seven years for Mitch McConnell and crew to give us the American Health Care Act (AHCA), last year’s half-hearted attempt at a replacement. There have been no public hearings. There has never been an attempt to craft serious legislation. There has never even been a serious attempt to improve and adjust the current law.

There was a decision last night in Texas. Americans are nervous. The president of the Federation of American Hospitals is clearly ticked off. The American Medical Association had filed a brief in defense of the law. President Trump has declared this court ruling a great victory. Of course he has.

DAVE

www.cunixinsurance.com

Picture – The Empty Field – David L Cunix

Beating The System

Open Enrollment season is coming to a close. The big challenge in Ohio is to pick the health insurance plan that will give you access to the doctors and hospitals you would want to utilize if you get sick or injured in 2019. If you are under age 65 in Greater Cleveland and paying for your own coverage, you only have one option to access the Cleveland Clinic, the Cleveland Clinic + Oscar plan. If you would like to get into the University Hospital system or Lake Health, you will choose Medical Mutual of Ohio. These policies are HMO contracts. Unless it is an emergency, you must use the doctors and hospitals in the system. Many of us have doctors in both systems. That doesn’t work. You must choose one system or the other.

This has put more than a few of us in a bind. Do you retain your cardiologist and find a new pediatrician for your kids? Which relationship is more important, the long held one with your psychiatrist or your comfort with your gynecologist? My advice to my clients is to choose the system, not the doctor. You can’t chase doctors. Not in Ohio.

As I’ve mentioned previously, I had a little health adventure in 2016. I took control of my care in early 2017 and put together a new team. A key member of this team is my oncologist. Great guy. He’s the one who orders the twice a year tests, including CT Scans, and then reviews them with me a week later. He always answers all of my questions. The last time we met I had one last question for him, a personal one. I wanted to know how he was doing since he seemed to be more focused on research than billable patient appointments. He assured me that he looked forward to our next visit in May 2019. I got a letter in the mail today from University Hospital that my oncologist had moved on and that the system would help me find a new doctor!

You can’t make a health insurance decision based on doctors. If you base your choice on doctors, you lose. You choose the system and find a doctor within it.

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I had a pain my chest. It had bothered me for about a week. It might have been just indigestion, but I wasn’t sure. I could go to the doctor. I didn’t want to blow $50 or $100. I found out that my friend, Frank, had the same pain. I talked him into going to having it checked out. If it was nothing I beat the system and saved some money. The next day I heard that Frank had died. I rushed over to the Cleveland Clinic and got an executive physical. $2,000! They poked and prodded me and then told me that I was suffering from indigestion. I went to Frank’s house and asked his wife if he had suffered. She said, “No. He died the moment the bus hit him.” A Woody Allen classic updated slightly.

DAVE

www.cunixinsurance.com

Picture – David L Cunix – A Different Bus