• Oh-Mama!-Care

    Posted July 1, 2013: by Bill Sardi

    Oh mama, the Affordable Care Act is unfolding in all its ugly glory.

    Americans are just now learning exactly how this piece of healthcare legislation is going to play out, and the realization of what it has morphed into is quite a disgusting chapter in current American history.

    Now before I proceed in telling you what Obamacare has morphed into, I want to go off on a tangent for a moment.

    On a momentary tangent: the unbanked

    In another industry, banking, there is a large segment of the population that is unbanked just like there is a large portion of the American population that is uninsured healthcare-wise.

    According to a federal government survey (there they go snooping again), more than one in four households (28.3 percent) are either unbanked or under-banked, conducting some or all of their financial transactions outside of the mainstream banking system.

    An estimated 8.2 percent of US households are unbanked. This represents 1 in 12 households in the nation, or nearly 10 million in total. Approximately 17 million American adults live in unbanked households.  The federal government knows precisely how many unbanked Americans there are by ethnicity, education, income level, age and even geography.

    According to the federal government, 29.3% of American homes do not have a savings account.  (Translation: they are not allowing banks to use their money as capitalization for lending schemes that have fallen into chaos as banks over-extended credit in recent times.)

    The federal government knows how the unbanked operate financially, how often they obtain payday loans, use pawn shops, use rent-to-own offers, etc.  The federal government says it has a “statutory mandate to estimate the proportion of households that do not fully participate in the banking system.”  (Page 4 of FDIC National Survey of Unbanked and Underbanked Households.)  The data appears to have been tabulated for the good of bankers, not the citizenry.

    There is good reason why the subject of unbanking is brought up in a report about the healthcare uninsured.  The new federal health law, called the Affordable Care Act (ACA), which requires most Americans (except Congress) to carry health insurance starting in January 2014, presents a problem since insurance companies generally accept checks or credit cards as payment for premiums, but just how are the unbanked going to make payments?

    The unbanked and the uninsured

    Will insurance companies require new enrollees to produce a bank account number?  This subject is being discussed.

    Surely the IRS, which is the enforcement arm of the Affordable Care Act (you pay a fine if you don’t buy health insurance, and it will be taken out of your bank account), needs a bank account to raid.

    By the way, also recognize that transaction fees for credit cards or pre-paid debit cards can run as high as 4%, which can be quite a bite out of the profits from private insurance plans under the Affordable Care Act.  (Another bonanza for the bankers?)

    I’m just wondering, if the IRS is not just limited to extraction of financial penalties from non-participants directly from their bank account and elects to take monthly insurance premiums directly out of a person’s bank account and forward them on to the insurance carrier, wouldn’t that serve to eliminate the 4% transfer fee?  Is that why the IRS has been brought into this program?

    Federal government stands in for bankers and insurance men

    The federal government sees itself as an agency both to promote (coerce) banking among the unbanked on behalf of the banking industry and to strong-arm Americans into buying health insurance on behalf of the health insurance industry.  The latter is what the Affordable Care Act is all about.

    Now it has been said that America has turned into an example of crony capitalism– when industry pays off government to obtain a preferential business climate.  But America has morphed into something worse than that.  It has become a fascist state when it creates public mandates citizens must adhere to.

    Forced or coerced vaccination as medical fascism

    For example, federal and state governments coerce Americans to undergo vaccination via school and work programs.  Vaccine makers don’t have to incur marketing costs, kids have to be vaccinated to get into school, young men and women to enter the military, etc.

    This might be acceptable if vaccination were all that it is claimed to be.  But it isn’t.  The flu vaccination program is a sham.  Flu vaccination doesn’t address the primary strain of the flu in circulation each flu season and doesn’t prevent deaths among high-risk groups – the elderly and the very young.  Yet the Centers for Disease Control essentially serves as a free publicity agency for vaccine makers, spreading fear over imagined pandemics to promote sales of vaccines.

    The same goes for the HPV (human papilloma virus) vaccine claimed to save young sexually active girls from acquiring a virus that may end up causing cervical cancer years in their future.

    But HPV clears in 70% of infected individuals on its own.  Vaccination only protects from 2-4 strains of HPV, not all 30 strains.  Provision of folic acid and vitamin C appears to quell HPV infection better than vaccines.  But state and federal governments are unceasingly pushing this vaccine on the public.

    Affordable fascism

    Congressman Ron Paul describes the Affordable Care Act as an example of fascism in healthcare, not just socialized medicine.

    When the Supreme Court upheld that the federal government can force its citizens to buy something, in this instance health insurance, it stepped over the line from crony capitalism to fascism.

    To be precise, the Supreme Court justices did in fact rule that the Affordable Care Act exceeds Congress’ authority under the Commerce Clause of the Constitution, but “read the statute not to impose a strict mandate to purchase health insurance but instead to levy a Constitutionally valid tax for failure to do so.”  This is an unfathomable trick – you pay a fine for not doing something.

    Not socialized medicine, semi state-run enterprises

    The U.S. government isn’t providing healthcare funded out of taxes like socialized medicine in Sweden or Canada.  The U.S. is said to be recruiting 9000 “customer service representatives” to man telephone lines (call 800 318-2596 or visit www.healthcare.gov ) and answer questions about private health insurance packages being offered under the Affordable Care Act.

    Say again?  Yes, you heard it right, the federal government is incurring the marketing and recruitment costs for private insurance firms and even answering the phone for them!  It’s everything but a state-owned business.

    While it is said 56 million Americans are uninsured, actually only about 11 million (3.6%) were truly uninsured. The more broadly disseminated figure of 56 million uninsured Americans included 17 million who elected not to purchase health insurance even though they had sufficient income to buy it. That is the primary target group insurance companies are covertly employing government to coerce into buying their product.

    Free advertising and promotion

    In some instances the States are funding the promotion of their healthcare exchange.  For example, California is putting up $43 million, Illinois about $28 million, Colorado $12 million.  Colorado has 13 participating insurance companies getting the benefit of all this for free.  Then the federal government is getting asked to kick in an additional $125 million for the Rocky Mountain state.  Don’t you wish your business had a free telephone room and a government subsidized payment plan, and free advertising via federal and state agencies?

    Will it live up to its mandate to save money?

    Is the affordable care act going to save newly eligible Americans money on health insurance premiums? 

    In Colorado the bare-bones, plain vanilla insurance package for an individual 40-year old nonsmoker is reported to start at $177/month. That “bronze level” insurance package in Colorado is going to cost $2124 a year, or about 11% of income of a low-income wage earner ($23,550).

    The Henry J. Kaiser Foundation offers a subsidy calculator for our hypothetical American worker, who has an income 205% above the abject poverty level. His unsubsidized insurance premium would be $3018 and he would receive a government tax credit of up to $1494 (49% of premium), and $1525 remains as his portion of the premium.

    Let’s see how much money this low-income wage earner has left after the federal government takes its taxes out of his check.

    If this insured person earns just above the poverty level of income ($23,550) and his employer kicks in half of FICA (deductions for Medicare and Social Security – 7.65%), then another $1801 is deducted from his paycheck (double this amount if self-employed).

    Then there is 15% federal income tax, or about another $3000.  So this 40-year old low-income worker is paying $3000 income tax, $1801 FICA and having to spend $1525 for health insurance, which leaves him ~$17,235 to live on.

    Guesstimating just $800/month for housing and $200/month car payment — deduct another $12,000/year, leaving this worker with about $4626/year to pay for food, clothing, car insurance, gasoline, etc.  Driving 12,000 miles a year in a vehicle that gets 20-MPG = 600 gallons X $4.00/gallon = $2400 for gasoline, leaving $2835 ($7.77 a day) for food, clothing, auto insurance, etc.

    This is barely do-able, so it’s no wonder so many Americans decided to chance it and go without health insurance.  Even with the Affordable Care Act, the uninsured may decide to take the penalty ($95 in 2014, $365 in 2015 and $695 in 2016).

    Does the ACA prevent personal bankruptcy?

    With the Affordable Care Act in place for this hypothetical American worker, insurance plans cannot raise his premium more than 10% without public justification (whatever that means), and he cannot be arbitrarily removed from coverage, and pre-existing conditions do not make him ineligible, and there are no lifetime spending limits on his care.  His selected health plan must spend 80% of its revenues on delivery of care or rebate money back.

    So it sounds like this fellow at least may avert personal bankruptcy if an unexpected and costly health crisis occurs.  But that is not quite the case.

    There are out-of-pocket costs for health care in ACA insurance packages being offered.  For exchange-sold plans, the maximum annual out-of-pocket cost is $6350 per individual, or $12,700 per family.  But that is not all.

    The cost of medical care is covered but prescription drugs may not be covered entirely.  This could still leave our beleaguered worker with a bill for $13,000 out-of-pocket, certainly enough to force him into bankruptcy.

    Oh, mama, the little guy is still getting pounded.

    The White House is bragging the Affordable Care Act has already saved Americans about $2.1 billion in rebates that have been paid by health plans that didn’t spend at least 80% of their revenues on provision of care.  Americans are never going to see through this ruse – the token rebates are simply being publicized to make the federal government look good while it takes billions of dollars of administration and marketing costs off the table for the insurance companies.

    Will it save money?

    The problem is, to BE EFFECTIVE, the Affordable Care Act has to take a big bite out of healthcare – hundreds of billions of dollars.  The Congressional Budget Office says up to 30% of health care in the U.S. is unnecessary.  Medicare faces unfunded future liabilities totaling $34 trillion over the next 75 years.

    While Title IV, Section 4202 of the Affordable Care Act spells out the components of a wellness program to include nutritional counseling, physical activity plan, alcohol and smoking cessation counseling, stress management, and dietary supplements that have health claims approved by the Secretary of Health Education & Welfare (that list doesn’t even include vitamin C cures scurvy), doctors simply aren’t trained to provide preventive services that they often consider beneath their training. Furthermore, the fee-for- service system that is now in place prioritizes services that produce the most insurance reimbursement.

    The Affordable Care Act runs off in two divergent directions.  One is to prescribe a regimen of preventive measures (vaccinations and health screenings like mammograms and colonoscopies) that will surely raise health care costs as more undetected and untreated pre-disease is detected, while at the same time the Affordable Care Act says it is going to ferret out waste fraud and abuse, invoke price controls and conduct comparative effective research to determine which treatments are the most cost effective.

    Treatment effectiveness analysis

    Evaluation of treatment effectiveness — let’s see if that ever happens.

    For example, preventive health screenings may be of limited benefit.  Colonoscopies offer only a remote chance of ever benefiting a patient.  Mammography may actually increase the risk for cancer.

    Ineffective and problematic drugs pose another difficulty.  For example, there are an estimated $11 billion of statin cholesterol-lowering drugs sold in the U.S. annually, many for healthy patients whose doctor thinks they need prevention of mortal heart attacks.  But statin drugs do not reduce the risk for mortal heart attacks, they meagerly reduce the risk for a non-mortal heart attack by 1 in 200 healthy users over a 5-year period.  In healthy adults, statin drugs are more likely to induce side effects like diabetes, muscle degradation, liver toxicity or even mental decline than to prevent a heart attack.  The risks outweigh the benefits.  But is the federal health program going to reject Medicare payments for statin drugs?  I wouldn’t bet on it, not with Big Pharma’s Congressional lobbyists in place.

    What about cancer therapies?  There are no cures for cancer.  The cancer care industry makes specious claims survival times are being lengthened, but in fact all that is being done is tumors are being detected and treated at an earlier and smaller stage.  Patients are still dying on the same calendar day.

    Chemotherapy only contributes to the 5-year survival of cancer patients 2-3% of the time.

    Another example is thyroid cancer.  The 5-year survival of thyroid cancer patients is said to be 96%, but even with 37,000 cases being detected and treated annually, the number of deaths from thyroid cancer (1600 per year) has not budged in 30 years.

    Is the Affordable Care Act going to disapprove payment for these ineffective therapies at the risk of being criticized of rationing care for dying patients?

    Manpower problems

    Another issue in delivering healthcare under the Affordable Care Act is manpower.  With millions more previously uninsured Americans now gaining insurance coverage, will there be enough doctors to go around?

    In Arizona there is speculation there aren’t enough doctors to provide the care for these newly insured patients.  There is similar concern being expressed in Wisconsin and Missouri.

    Here is another instance where the Affordable Care Act is talking out of two sides of its mouth.  It wants price controls, it wants to cut physician’s fees, but for States that are expanding their Medicaid program to accommodate uninsured citizens, physician reimbursement may not be adequate to provide the promised care.

    For example, Medi-Cal is said to be “such a broken system with really abysmal reimbursement rates” that providers are electing not to participate.  Medi-Cal pays $18-24 for a basic office visit, which is scheduled to fall to $14-15 as State budget problems are addressed.

    Summary

    The Affordable Care Act could implode on its very first day.  Its most disturbing reality is that it doesn’t serve the little guy very well.  However, it does reduce recruitment costs and expands the list of customers for insurers.  It may also be used as a covert way to coerce unbanked Americans to put their money in banks.  Americans just above poverty-line income levels, who may be eagerly awaiting receipt of an insurance card for the first time, may not have enough money to pay for out-of-pocket costs, may not even be able to find a participating doctor to deliver care, may not avert personal bankruptcy in the event of an unexpected costly health emergency, and may not even be able to pay for insurance premiums themselves.  Oh mama, the Affordable Care Act may be a failure right out of the starting gate.

    Mama, say it isn’t so!

    ©2013 Bill Sardi, Knowledge of Health, Inc.

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