Wednesday, July 23, 2014

Obamacare: Big Socialist Takeover That Wasn't

Here we are nearly 8 months into the full rollout of Obamacare and in spite of all the "patient protections" in the Patient Protection and Affordable Care Act insurance companies still aren't playing nice.
No law has done more to reform health insurance and protect consumers against the industry's most heinous practices than the Affordable Care Act. But Obamacare didn't magically transform insurers into benevolent entities solely devoted to taking care of sick people. 
Health insurance companies, even those that are not-for-profit, have to collect more money in premiums than they shell out in claims for medical care. That means they have a financial incentive not to pay for things. 
And since health insurance companies can no longer shun the sick to maximize profits -- either by denying coverage to people based on their medical histories or by rescinding the policies of paying customers who fall ill and rack up bills -- insurers are employing other tactics to shift costs to sick people and make it harder to get health care, consumer advocates say.

Insurance companies can no longer deny coverage based on preexisting conditions. But they have dreamed up ways to comply with the letter of the law while ignoring the spirit.
By structuring their health plans a certain way, patient advocates say insurers are discriminating against some patients by forcing them to pay the highest tier drug costs for certain prescriptions—or by discouraging them from signing up from the plans, leaving insurers with only healthy patients. 
In Florida, for example, four insurers – Cigna, CoventryOne, Humana and Preferred Medical – have been accused of discriminating against people with HIV/AIDS. A recent complaint filed with the Health and Human Services Department alleges that the insurers placed all covered HIV/AIDS prescriptions in the highest drug tiers requiring patients to pay significant out of pocket costs---sometimes an upwards of $1,000 each month.
The truth is that there is nothing extreme about the ACA. It's just some common sense reforms that perhaps don't go far enough. By painting it as something radical, conservatives are ignoring objective reality and simply making themselves look foolish.

This case brings to mind the axiom 'be careful what you wish for.' Republicans were right, strategically at least, to try to stop the ACA from taking effect before millions of Americans were receiving coverage from it. If they by chance succeed in dismantling and unraveling coverage for millions now receiving subsidies they will be the dog that caught the car.

11 comments:

Anonymous said...

Obamacare Schmobamacare....what about the increasing infection rates of HIV in young gay and bisexual males?

I am interested in your views on that tragedy.

Do you believe it is because young homosexuals are having riskier sex because they are not able to have more open and committed relationships? Or, some other cause?

This is an important discussion that should be had.

Godwhacker said...

Dear 12:00,

You sure do ask a lot of questions for someone from New Jersey.

I actually do work in the field of HIV prevention so this is something that I know and care about.

HIV/AIDS is no longer a death sentence and so it's not commanding the same fear and respect that it used to. In some ways that's good. In some ways that's bad.

We simply aren't getting the message of safer sex out to young people in places where they can see it. The Florida state government, with its obsession with abstinence only education and other prohibitions, effectively ties our hands and limits our messaging choices. For example, I have personally put forward the idea of reaching out to young gay men in social media, apps, and ‘hook up’ sites. That’s where people are meeting for sex these days, but the state will have none of that. So we do what we can with private funds.

There is another related issue with the emergence of pre-exposure prophylaxis or PrEP, the idea of taking HIV meds by healthy people to prevent infection in advance. This is also a double edged sword. Even if it is 100% effective against HIV infection there are a lot of other STDs out there that it won't provide protection from.

For generations gays had to hide to have sex. That’s not true anymore. People like myself who form stable long term relationships provide another role model archetype to a sexual culture that was, by necessity, based on transient sexual experiences. But people like myself are a relatively new phenomenon. It’s going to take time for our example to proliferate.

“Treatment is prevention” is the new catchphrase du jour among HIV activists. Study after study has shown that it is all but impossible for a person on effective antiretroviral therapy to pass the virus on to someone else. If we got everyone tested and everyone positive on effective treatment we could stop HIV in its tracks with current technology. Games, like the one’s being played by insurance companies in this post, stand in the way of that.

Anonymous said...

"Do you believe it is because young homosexuals are having riskier sex because they are not able to have more open and committed relationships." The use of the term "more open" renders the sentence senseless.

Anonymous said...

Most coherent post by Gw ever. Bravo.

Godwhacker said...

I can take any insult, but please please don't call me coherent!

Anonymous said...

GW - there are plenty of websites out there that encourage safe sex and the use of condoms for men sexually involved with other men. Billboards advertising the necessity of HIV testing were or are still up next to I-95.

You can't rely on the govt to do the work for you so you will have to do it yourself. YOU can reach out to young gay men by creating your own app or by buying advertising on hook up sites (probably not that expensive). Private enterprise is a wonderful thing and is usually a far more effective way of reaching today's young than is the govt. You need to figure out where the young kids, gay and straight, and somehow make them "feel"the message of safe sex.

The problem is not only with young gay men, but with heterosexual young men involved in heterosexual relationships. Young men do not think clearly when they are in the throes of passion.

Young men, straight and gay, are transient by nature. Being in a loving, long term monogamous relationship, whether married or not, is great, but you are older. It is an example to be emulated but you are missing the boat on this - the issue is not long term monogamy but safer sexual practices while single and young.

You also failed to mention that the rates of infection in the black and latin communities is far higher than it is in the white communities. You cannot attack this until the differences in the various communities are recognized and properly targeted.

By the way, people like you, in long term relationships are not new. They are just more open. I am a straight, happy married male in my early 50s who has lived in many places. Gay couples have always existed regardless of the climate towards gay marriage and gay couples will continue to live together even if gay marriage will never be the law of the land. You simply cannot tell a reckless young man, gay or straight, of the beauties of monogamy and family life, because they just don't get it.

To quote the 90's philosopher Q-Tip from A Tribe Called Quest, "But sex was on my mind for the whole damn route, My mind was in a frenzy and a horny state...."

Godwhacker said...

@9:13

You make a lot of good points. No, gay couples are not new but the openness is new. Introducing my spouse as my spouse is new. The example of healthy, happy gay couples living in the light is new.

We can debate private versus public funding all day but the fact remains that we have a considerable public budget for the exact kind of messaging I'm talking about only we are prohibited from doing it. If we're going to spend public money let's spend it wisely, no?

That said we do a lot with private funding and a hat tip to The Elton John AIDS Foundation for being an integral part of that.

And thanks for pointing out that this isn't just a gay issue. The impersonal nature of today's hookup culture crosses all genders and orientations.

Another issue we haven't touched on is drug use and it's part in the epidemic. People are less likely to use protection when they are blasted out of their minds.

But as I said the science for stoping HIV/AIDS in its tracks exists today. All we need is the will to eliminate the barriers. I've written before on the topic of HIV criminalization, and that stands as one of the most potent barriers to universal testing and treatment.

Anonymous said...

GW

You probably know about this, but again, the issue is responsibility. You will have to copy and paste the link:

http://www.nydailynews.com/life-style/health/condoms-virus-killing-lube-article-1.1878467

Yeah, I really wish the govt would loosen up a bit and realize that HIV / AIDS effects EVERYONE in society, not just the people who are infected and their families. Half a million dollars worth of money that goes towards prevention could easily save 10x that in medical care that could be used where it is really needed, had someone just received the right message.

People will be people; if they behaved the criminal lawyers would be out of business, and the civil attorneys would have nobody to sue because contracts would be honored.

The issue of getting people to behave is as old as time itself. Following the typical Judeo Christian lore (and ignoring the other sources that predate the Bible) Cain killing Abel was the first recorded murder. Some think Abel was killed because Cain was jealous of the way Abel showed him up in front of G-d; others think he was killed over a woman who might have been their sister (long story).

The govt. just thinks that they can legislate behavior that occurs in the privacy of peoples' homes, when they cannot. As a Yid, I do not want Christian or Moslem mores shoved down my throat, especially in my own home, by a Governor who may have a religious agenda.

I cannot write more without giving my identity away. If there was a way for me to write more to you privately, I would.

Godwhacker said...

I can be emailed at godwhacked@gmail.com

The link is interesting, but this is not the first time HIV killing lubes and condoms were available. Condoms and lubes with Nonoxynol-9 were recommended, even pushed back in the 80s and early 90s. As it turns out it wasn't a good idea. The substance irritated the skin causing abrasions and lesions which actually increased the likelihood of transmission.

Hopefully the science is better this time around.

But yes, once you've rejected a basic moral tenet like heterosexuality it's easy to disregard others. I remember as a young man building up my own moral code and deciding which sociological norms were good and which could be passed over. That's a conversation too few have with themselves.

If you've seen the movie "The Normal Heart" it does a great job of capturing the 'free love' atmosphere of the late 70s and early 80s that lead to the proliferation of HIV/AIDS. No matter how far our science advances towards cures, treatments, and vaccines that's not a place we should want to go back to. No one heard of AIDS back then. It didn't exist and the next pandemic is out there waiting for us somewhere.

Anonymous said...

Just ask Spence... he knows.

http://www.huffingtonpost.com/spencer-aronfeld/does-florida-really-hate-gay-marriage_b_5614283.html

South Florida Lawyers said...

Hey, Spence is on to something there (besides his red jacket).