The Affordable Care Act ignores simple issues of human nature

The Affordable Care Act (ACA), aka Obamacare, is law.  And its implementation is moving along slowly, but steadily.

You have to give credit to the folks who believed in it, whether grass-roots supporters or highly placed politicians.  They rammed it down the American gullet like a lead ball down the muzzle of a Hawken rifle.  The problem is, once it goes off, the whole thing is going to explode.

The reasons are many, but from my perspective in emergency medicine, there are some very important issues that the crafters and supporters of the law either failed to notice or (more likely) intentionally ignored.  While I’m not a medical economist, or a politician for that matter, I am a physician. And as a physician, I pretty darn good observer of humanity.

As the cost of insurance rises, people with limited incomes are simply going to pay the fine and go without insurance.  Rather than pay $900/month for their families, they’ll pay the $695 yearly fine … unless of course the qualify for various exemptions.  For some young people, this will be fine.  But many will still be ill and will still show up in emergency rooms, as they have for decades, in the full knowledge that they’ll receive good care and simply be billed later.  But not to worry!  They can still apply for insurance as soon as they need it and not be denied.  Problem is, the concept of insurance then fails. They won’t have put any money into the system, which could have been making money for the company until they became ill or injured.

Of course, many won’t bother with the fine either.  And it’s the height of lunacy to believe that the government (which simply can’t imagine imposing voter ID) will actually track down and prosecute those who don’t pay.  If it did, they would just call a reporter and talk about how they have no money for insurance and the fine would be dropped.

I take care of a lot of folks in this demographic.  Some genuinely have financial struggles and try their best. I love them.  But a not-insignificant group of patients will continue to find ways to move from ER to ER, from narcotic prescription to narcotic prescription, state Medicaid to state Medicaid.  They will still find money for a smartphone, cigarettes and methamphetamine.  They will continue to drive large, late model trucks and fish whenever possible.  They will not give accurate addresses, either to the government or to the hospitals who treat them.  And they will not abide by the rules of the Affordable Care Act.  That is, they’ll find a way to have money. But they aren’t foolish enough to use it for insurance.

Added to the problem with the ACA is the issue of pre-existing conditions.  I’m sympathetic here. I have a son with type-I diabetes and a wife who is a cancer survivor. Insurance will be tough for them to obtain without some government mandate.  On the other hand, what about the patient who intentionally does things, or has habits, which make him or her a costly investment?  For instance, the recreational cocaine user?  The heroin addict who has no interest in rehab, only in treatment when things go wrong? The gangbanger whose hobby is shooting others and being shot? It may seem compassionate to offer them help; but it’s cruel to those who will be ultimately paying the costs for those who refuse. It’s a huge drain on a system when people do nothing to care for themselves.

Finally, what does the president intend to do about the fact that physicians are retiring early, and moving into practices that don’t take insurance?  What about the fact that there aren’t nearly enough physicians in primary care, nor will there be for at least the next 20 years or more? What about the fact that patients who are difficult are often dismissed from practices?  What do we do with the angry, the addicted, the dangerous, the non-compliant?  Even with insurance, nobody will take care of them for long.

I’ll try to be generous here. The ACA exists in part because of compassion for the sick and needy.  I’ve known patients who simply put off necessary care for lack of insurance.  But the ACA is far too large, far too expensive and ignores simple issues of human nature and behavior like those I listed above.  It also ignores other inconvenient truths; like employers changing employees to part-time because they can’t afford insurance, or the impending explosion of patients who haven’t paid into any plan, private or public, because they were illegal immigrants.

Frankly, I’m worried. When government, so far out of touch with reality, imposes its social philosophy on people who do live in reality, only tragedy can result.  What a pity that when it happens, the political class (left and right) will only wring their hands, say ‘tsk, tsk, we didn’t think that would happen,’ and slip off to their private physicians, with their Cadillac, tax-dollar insurance plans, and get more pills for anxiety.

And the masses be damned, or fined, or ignored.

Edwin Leap is an emergency physician who blogs at edwinleap.com and is the author of The Practice Test.

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  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    I’ll be slightly less generous here (coming from the far left): If the “ACA exist[ed] in part because of compassion for the sick and needy”, then it would look a lot different than it looks now, or maybe that “part” is way too small to overcome the other parts….

  • querywoman

    Most people live paycheck to paycheck and spend all their disposable money. Requiring them to dip into their monthly funds for health insurance won’t work.
    I predict only the uninsured upper middle class will happily buy into the ACA. Of course, many of them spend all of their high monthly incomes now also.

  • amohtap

    this entire post should have been 4 words.

    “fuck you got mine”

  • http://www.dpsinfo.com LaurieMann

    And, Americans, as usual, aren’t asking the obvious question: If America has the best healthcare in the world, why does almost every country with a single-payer plan report higher life expectancy than the US? We have the most expensive healthcare in the world, but I don’t see that we have the best.

    • Just Wondering

      Because many things affect life expectancy besides health care … most importantly lifestyle

      • amohtap

        Even when corrected for lifestyle, Americans pay disproportionately more for worse outcomes.

        This is undisputable, undeniable fact.

        • morebuzzkills

          Please share this data.

        • Mengles

          Link to that article please? Don’t just pull thing out of your you know what.

          • morebuzzkills

            It’s kevinmd…I’m pretty sure that’s the only place comments come from! I would be interested in seeing where this data came from though.

          • https://www.facebook.com/arobert6 Alice Robertson

            No it’s online and you just have to run a search on the WHO stats and the IMR’s. I actually thought it was common knowledge. Also, if you do so just compare the gun shot deaths here and deduct from the stats and you find WHO was all messed up. I find it amusing though when people balk because after living in UK I am like, “Oh so you wanna deliver your child in Europe and not here?” After they get dogmatic about how correct WHO is. Odd though they don’t want to deliver there, but want to hold Europe up as some type of role model in medicine. Oh good God….go live there and get some of that care then come back and appreciate it here a bit more. A doctor at Cleveland Clinic did a semester there and came home terrified:)

            I found the stats in about one second using Google. It’s all over the internet and I have read it several times. Just go to National Review and read up on Infant Mortality: A Deceptive Statistic

            Snippet: Underreporting and unreliability of infant-mortality data from other countries undermine any comparisons with the United States. In a
            2008 study, Joy Lawn estimated that a full three-fourths of the world’s neonatal deaths are counted only through highly unreliable five-yearly retrospective household surveys, instead of being reported at the time
            by hospitals and health-care professionals, as in the United States.
            Moreover, the most premature babies — those with the highest likelihood of dying — are the least likely to be recorded in infant and neonatal
            mortality statistics in other countries. Compounding that difficulty, inother countries the underreporting is greatest for deaths that occur very soon after birth. Since the earliest deaths make up 75 percent of all neonatal deaths, underreporting by other countries — often misclassifying what were really live births as fetal demise (stillbirths) — would falsely exclude most neonatal deaths. Any
            assumption that the practice of underreporting is confined to less-developed nations is incorrect. In fact, a number of published
            peer-reviewed studies show that underreporting of early neonatal deaths has varied between 10 percent and 30 percent in highly developed WesternEuropean and Asian countries.

            Gross differences in the fundamental definition of “live birth” invalidate comparisons of early neonatal death rates. TheUnited States strictly adheres to the WHO definition of live birth (any
            infant “irrespective of the duration of the pregnancy, which . . . breathes or shows any other evidence of life . . . whether or not the
            umbilical cord has been cut or the placenta is attached”) and uses a strictly implemented linked birth and infant-death data set. On the
            contrary, many other nations, including highly developed countries in Western Europe, use far less strict definitions, all of which
            underreport the live births of more fragile infants who soon die. As a consequence, they falsely report more favorable neonatal- and
            infant-mortality rates.

            A 2006 report from WHOstated that “among developed countries, mortality rates may reflect
            differences in the definitions used for reporting births, such as cut-offs for registering live births and birth weight.” The Bulletin of WHO
            noted that “it has also been common practice in several countries (e.g.Belgium, France, Spain) to register as live births only those infants
            who survived for a specified period beyond birth”; those who did not survive were “completely ignored for registration purposes.” Since the U.S. counts as live births all babies who show “any evidence of life,” even the most premature and the smallest — the very babies who account for the majority of neonatal deaths — it necessarily has a higher neonatal-mortality rate than countries that do not.

          • Teresa Drummond

            I’d say having given birth on both sides of the pond that the midwife UK experience is second to none…that part of the Nhs is still excellent

        • Tiredoc

          Disproportionate:

          Americans spend a lower portion of their income than health care than
          people in subsistence (less than $1/day) economies if all forms of health care are included.

          Dispute:

          Americans do not have worse outcomes when evaluated by either treatment or by diagnosis.

          There is every reason to presume a variable life expectancy by race and social class. Adjusting for lifestyle ignores the genes. Have to adjust for those too.

          Deny:

          Americans count as live births babies that every other country counts as stillborn because they don’t live out the work shift. Makes a huge difference in the longevity and infant mortality statistics.

        • Suzi Q 38

          Prove it.
          A link to an article or study, please.

      • morebuzzkills

        Wait, you mean physicians can’t fix everything?! Where did you hear these lies?

    • Mengles

      That’s bc that obvious question has an answer. If you actually look at the LIFESTYLES of their citizens (diet, exercise, etc.) it’s no surprise at all. Maybe if people didn’t believe that healthcare fixes everything without responsibility on your part, we’d be a lot better off.

      • Teresa Drummond

        there is so much blame with illness, what you have to remember is that people inherit problems and then get fobbed off… I was sick since childhood, certain I’ve had a tumour and kidney problems all of my life now I look back and analyse it all…the quality of doctoring must be upgraded ime So to say lifestyles is the issue isn’t always the fair summing up and remember the stressful, toxic, nutrient deficient food we eat, the more I learn the more i’m amazed any of us are well tbh I’ve experienced Canadian and England medical care btw

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      Some of us have the best health care in the world. Others not so much so. “Unfortunately”, life expectancy is calculated across those with and those without.

    • guest

      don’t see why there are down votes. this is just a fact. Studies have been done that clearly show our health system is not the best.

    • Michael Rack

      “If America has the best healthcare in the world, why does almost every
      country with a single-payer plan report higher life expectancy than the
      US”
      Much of US healthcare expenditures are focused on improving quality of life, not increasing life expectancy. Examples: much of dermatology, knee (and other orthopedic) surgeries for weekend warriors, most of back pain treatments, etc. Life expectancy can not be the only measure that the US health system is judged on.

      • ninguem

        Life expectancy is determined by genetics. With certain basic public health measures in place, so you don’t die of infectious disease, your lifespan is determined by genetics.

        Swedes have a long lifespan. So do Japanese. Swedish-Americans, Japanese-Americans, their life expectancy is the same here as in Sweden and Japan.

        Blacks have a shorter lifespan. That’s true in Africa, and with Afro-Americans, or Afro-British, or Afro-French.

        Somehow, that shorter life expectancy in England or France is due to genetics, but in the USA its because of our evil capitalist healthcare system.

        • https://www.facebook.com/arobert6 Alice Robertson

          About a year ago TIME magazine devoted an issue to this and it came back that life expectancy is only 20% genetics. I can’t remember the other percentages…I just remember reading and doing a double-take on it. They had very good sources. Gosh I hate to quote without the article but it’s after midnight and I can’t be bothered. I thought they based it on the NIH and the genome project?

          But I don’t agree our life expectancy has anything to do with what I consider the world’s greatest healthcare. The US is where every person posting would seek out if their child had cancer. Maybe you were being cheeky? Or just a curmudgeon? I do know the WHO list from ten years ago was a right mess up of a list and they haven’t issued one since and I don’t believe they intend to. They did an unfair comparison of the countries which is typical.

          There are just too many factors going on from environment, inflammation which we know is food and exercise, etc.

        • Teresa Drummond

          Part of the problem now besides toxins is the fact our soils are so darn depleted of minerals and vitamins…then you get people inheriting deficiencies and the medical profession ime don’t understand all this…it is rather like a puzzle figuring it out…but for example mineral deficiencies can lead to oestrogen dominance…that alone is a big deal health wise and rare information ime… Mineral deficiencies can rarely be tested for too…

      • https://www.facebook.com/arobert6 Alice Robertson

        Ugh…not the WHO stats:). The very foundation of that messy list is up for grabs. And surely we now know that between healthcare costs and Medicare and Social Security going for the gold is taking on a new meaning!:)

        The thing that is bothersome with countries like Canada and the UK (I use them as examples because of residency in them and proximity). When people die on waiting lists without seeing a specialist or no diagnosis they aren’t even important enough to be a statistic. Waiting on care can be no care or by the time you get seen it’s basically right into hospice where there are medications we can get that they can’t. It’s highly frustrating to see people naively think they want that kind of care.

        • Teresa Drummond

          yes I agree and don’t forget the keen attitude of many to fob off the patient until so ill they land in hospital then Liverpool Pathway used covertly…I ran or rather hobbled out of a hospital at 2am on account of that…got away just…Seems the UK system is just about denying a lot of people care ime Wouldn’t wish this on anybody

          • https://www.facebook.com/arobert6 Alice Robertson

            You are honest! I would love to chat with you. Please write to me at: alicerobertson@ameritech.net or I am FB at arobert6 Anyhoo…nice to meet you Teresa.

          • Teresa Drummond

            Thank you love :D I’m rarely online just pop on energy permitting. I can’t see the point in being anything other than honest tbh but it does seem to make me an oddity. I’d rather just keep communication on here, keeps it simpler for me :D Thank you for the follow and as soon as I figure out how to follow you back i’ll reciprocate

          • https://www.facebook.com/arobert6 Alice Robertson

            Sure! If you are in the UK maybe we could meet if I go back. My husband and kids were there in March and are heading back in about nine months. But I realize I should write privately to you about chit chat….but hey it’s healing!

          • Teresa Drummond

            I’m mostly bedbound and can’t sit up beyond 30min once a day and sometimes not even that…my path to recovery will be long…but thank you for the invite.
            I take it from your earlier posts you live in Canada? I grew up there from 5 to 26 but was born on an RAF base in Germany, Dad was a pilot…I returned to the UK in 1989…my health fell apart as soon as I arrived and the Nhs just kept saying nothing was wrong with me lol…Chocolate Tea pots come to mind…anyway that’s me…

          • https://www.facebook.com/arobert6 Alice Robertson

            Omgoodness….our experience with the NHS is terrible too…too many dead relatives. I am so sorry to hear about your illness and deferred diagnosis. If I can help you do research please give me a shout…across the pond:) But that said….no I live near Cleveland Clinic but lived in the UK many times (I used to go back and forth a lot…but the kids weren’t happy there….few relatives here in the states). Met my husband in Scotland…yeah…those rascally Scots:) But I lived in England a bit too.

          • Teresa Drummond

            Anyway I’ve had my fill of the laptop now…so will be offline for at least a week possibly more; it’s been very nice talking to you :D

    • lissmth

      Life expectancy doesn’t include just medical care. It is an all-cause statistic. America has significantly higher cancer survival rates than any socialized system. Whether those outstanding rates continue under Obamacare is yet to be seen.

    • Suzi Q 38

      If our healthcare is not the best as you say, why do so many Canadians and foreigners from other countries come here for their surgeries and other health care? Try getting care in another country during a true emergency at night.
      Your surgeon goes home at 6:00 PM. (Look what happened to Princess Diana) You can not get referrals so easily. There is a wait list, and you might not live to make it to your surgery date.

      Our Canadian friend needed a heart bypass. He was having severe chest pains, so they discussed it as a family and decided to seek medical care in the U.S.
      He had to withdraw over $100K from their retirement and savings and then drive down to the state of Washington in order to have his surgery ASAP. He was not going to wait and test fate. He knew how bad he felt.
      I know we complain about out health care system, but other countries may be worse.

  • karen3

    The biggest problem is that ACA worsens the cost curve problem, instead of addressing it. There are very few things that have really been “proven” to be effective preventative measures for the generally healthy and the two biggest — don’t smoke and exercise – are not much within the purview of the medical profession. ACA layers huge and expensive mandates for wellness prevention that is likely pure waste, at the cost of availability of physician services for those who have chronic illness, were additional health care dollars really do result in savings. ACA will certainly result in a serious reduction of services to that beneficiary pool, who will become complete medical pariahs. It is very pro-big medicine and anti-small practice. When you consolidate an industry (and medicine is in industry, not a profession) you will see price increases, not decreases. And quality will be less because of the few alternatives.

    It’s too bad because the problem of insurability is really a function of the underlying cost of what is being insured against. Addressing the cost curve could have fixed two issues at once.

    • buzzkillerjsmith

      Well put. The “bending the cost curve” rhetoric is risible. It won’t happen unless the feds get deep, deep into the details of how medicine is practiced or unless they just slash funds. Both paths are problematic and could cause the American people to erupt.

      Preventive medicine is vastly oversold and does not do much, a few interventions like immunizations and screening colonoscopies excepted. The aggregate health status of the population in this country is mainly determined by environment, not medical care. Curious that this simple fact is not part of the chatter.

      The ACA is an administrative mess, especially the EHR and meaningful use parts. The PCMH and the ACO nonsense are also misguided. Obvious sops to corporate interests that will have the effect of forcing even more docs into CorpMed where we will make damn sure that the Pap smears and alcohol surveys are up to date but won’t be so interested in people with fever and shortness of breath.

      • southerndoc1

        Agree with much of what you say, but EHR and MU mess aren’t part of the ACA.

        • buzzkillerjsmith

          Thanks.

        • http://onhealthtech.blogspot.com Margalit Gur-Arie

          That’s true. However, ONC and CMS and their myriad of committees have repeatedly stated that the Meaningful Use program design is being evolved to support health reform, so the “EHR and MU mess” has been and will continue to be heavily influenced by the ACA.

      • Teresa Drummond

        That last bit about Pap smears and alcohol surveys being done but not being interested in fever and shortness of breath is exactly what I’ve seen in England…and when they find you have an expensive condition they duck and dive to avoid you sadly and getting the truth out of them is nearly impossible. What you get is ‘your test results are all fine’ When in fact you are very sick I make a point now to avoid the pap and mammograms as a protest, neither I have much faith in anyway given my health situation and lying doctors

    • bill10526

      Well said karen3.

      It is a fact that President Obama and most Democrats listen to absurd advice in many areas. Lead nuts made bicycles illegal for a while because of brass in bicycle tire air valves. That is why I was pleased with Senator Grassley’s pledge to work in good faith with Senator Buacus. Then Grassley pulled out. Shame on him! The basic working of the ACA seems sound to me, and coming up with examples of people gaming the system is silly. My wife works hard as a home health aide. She is excellent at it. Her annual gross take is about $20,000. A $6,000 health insurance bogey is hard to do. That problem does not come from the ACA, but is HR 101 theory.

  • Anthony D

    About 57% of uninsured people have a Dr. visit each year and cost the
    taxpayers money. But this is not the main reason for costs going up on
    premiums. It is paperwork to adhere to government regulations. Redundant
    paperwork accounts for 18% of healthcare costs. Admin accounts for 14%
    of healthcare. Transcriptionists, Recording systems, duplicate site
    backups, hippa software etc… All of it adds up to 80% of a healthcare
    costs.

    • morebuzzkills

      Can you share where you got these numbers?

      • guest

        qre you related to buzzkillerjsmith? LOL

  • Anthony D

    According to the Article 1, Section 7, of the United States Constitution
    any legislation to create a tax to be collected by the federal
    government must originate in the House of Representatives. This is known
    as the Origination Clause. PLF claims that the original bill that was
    used to create Obamacare originated in the Senate and not the House,
    thus making Obamacare illegal. Based on this information they are now
    moving forward with the case in the court system.

  • Allie

    I think at some point we are going to have to accept that there are very few perfect patients who did absolutely everything right and therefore deserve our care. The author can claim that addicts are a reasonable argument against the pre-existing conditions. I think we simply don’t know enough about most diseases, even the well studied ones, and particularly addiction, to say what is or isn’t any one patient’s failing as a person to deserve our offering them only the least and worst care.

    • Teresa Drummond

      Yup I agree fully, really sick of the judgment within the medical profession; it was never meant to be thus it was meant to be a caring profession…I’ve read my medical history…it makes me very very angry to hear any judgment…look at the patient and do the best or don’t be a doctor in my books…sorry but part of my problem with the Nhs was they judged my personal life…that had been impacted by the health they neglected…so annoying and hurtful

  • dontdoitagain

    I sense a little resentment here? These horrid patients drive a late model pickup? So in order to get medical care we should take the bus? We shouldn’t have a smart phone? You do realize that medical care costs far more than those things you mention and even IF we give up everything we still won’t have enough money for medical care? As far as I can tell heroin use, methamphetamine use, cigarettes are all addictions. I’ve heard tell these are hard to stop/control. I don’t believe for one minute that any of these addictions costs more than medical care.
    I’m wondering just how much I have to give up in order to get medical care. I worry constantly now about getting ill. I can’t seem to stop growing older… Do I have to give up driving, even my OLD pickup? Do I give up eating? How do I get to work? My job is erratic, can’t get busses and besides I need to get there on time. Do I live under a bridge? Who can afford rent and medical care both?
    Just how perfect do I have to be to be worthy of medical care? The “Affordable Care Act” is a nightmare designed to bail out the health care industry. It sure isn’t to make health care costs more in line with the actual INCOMES of people! How snarky to suggest that only perfect, wealthy people are deserving of attention. How can you imagine that we patients should live on a street corner in order to save money for an impossibly expensive health care system?
    Take it one step further doc. Outlaw motorcycles, swimming, football, horses, skate boards, smoking, drinking, promiscuity, homosexuality, sugar, starch, I could go on. Just force people to behave like you want and see how much health care money is actually saved. I’m betting NOT MUCH. We are still going to grow old and get injured or sick.

    • May Wright

      “I sense a little resentment here? These horrid patients drive a late
      model pickup? So in order to get medical care we should take the bus?
      We shouldn’t have a smart phone?”

      He’s talking ab out people who want free healthcare, who will not pay for health insurance or pay their medical bills because they “don’t have the money”, yet they obviously HAVE money, they just decided to spend it on other things.

      So yes, there is a little resentment when people are demanding that I, who went WITHOUT a lot of nice things, especially early on, in order to pay for my own health insurance and healthcare needs, pay for THEIR medical care so that they DON’T have to do without their luxury goods.

      Most people don’t mind giving charity to the truly needy, but DO baulk at being forced to give up part of their paycheck to people who have nicer stuff than them.

    • Teresa Drummond

      Just don’t give up the food…ime the right food can keep you very healthy…Part of the problem is some people have it easy and some don’t and those that have it easy will never understand in a million years how hard it is for the others…and the choices…I did nightshift to eat…that in part is why I got ill…comfy middle classes wouldn’t get that…

  • http://euonymous.wordpress.com euonymous

    I agree with your observations, although my conclusion is different. It seems to me that single payer healthcare offered to everyone is the solution. But then my observation of ramming a lead ball down an old rife and then firing it is that you will lose an eye in the experience; as did a cousin of mine. Old guns are unstable, as are old social strategies.

    Years ago, when the US healthcare system worked, the difference between the income of the 1% and the 99% was much much smaller. The concept of having health insurance made sense. Companies started to underwrite health insurance during a period when they were competing for employees. That is not so much the case today with massive unemployment (some obvious and some hidden). It would be nice to reinvigorate a US middle class. But until that happens, the top 1% of US income recipients can contribute to universal healthcare. By the way, Japan has had a law for many years that the salaries of the top earners in a company and the lowest earner can differ by a maximum of 20:1… an unthinkable number in the US where 2000:1 is not uncommon.

    • lissmth

      It is not an American value to confiscate those who worked hard and achieved. Only prosperity and growth will narrow that gap, and we haven’t seen prosperity and growth for many years. Obamacare has just made the disparity worse.

  • bsaunders

    I hear you on the system abusers. But the other side of it is how it is reasonable for a 50-year-old whose worked all his life and now has been laid off should be bankrupted just to ensure that gang bangers and drug abusers get what they deserve.

  • petromccrum

    Couldn’t agree more. this is a huge waste of money that is not going to accomplish one thing. It only creates more problems and expense for those individuals that want health insurance.

  • guest

    Well written article. For the kind of person that takes on responsibility and works hard in their life Obamacare does solve one kind of problem I have found disturbing. If they get a disability from a medical problem and are laid off of work they can be fired from their job AND lose insurance all at the same time under the current system. That seems unethical. Or the scenario of someone feeling held hostage to keeping a plan because of a preexisting because if they don’t they will lose insurance forever–under the current regime. I think this solves at least the problem for that kind of scenario not to say it does not have its problems.

  • lissmth

    Excellent article. Guaranteed issue and an early-buy incentive could have been written in a few pages. We didn’t need 159 new bureaucracies, numerous life valuation panels, 16,000 IRS agents, a national medical dossier on each of us, 21 taxes and more trillions in spending. I can’t buy what I want anymore so may decide to buy nothing.

  • guest

    I think if you are under a large group plan you can have pre existing. but i can stand to be corrected. that was my impression. I think the people that have the most trouble are self insured. But I am delighted that will change.

    In the current state it is truly hard to get insurance. Anyone who sees a psychiatrist even once is likely to have problems getting insurance, even meniscule things become huge to some of these insurance companies. just normally expected things like cholesterol or htn for middle age folks are that are well controlled
    . Migraines are huge triggers for insurance companies that think you are going to use the ER frequently and will frequently deny coverage. So pre existing is getting extreme. It no longer even means serious pre existing. Basically insurance companies screen people and in my experience only the completely healthy people under some plans are the only ones that get in.
    God forbid anyone should have diabetes.

    • Suzi Q 38

      “…..God forbid anyone should have diabetes.”

      Then don’t treat fat people over 50.

      Thank goodness my husband works for a medium sized municipal city and we have good health coverage for now.

      With my health history, starting in 2011, my existing conditions do not look good on paper. I would not be able to get my own insurance due to my pre-existing conditions.

      • guest

        sorry to hear that. It’s terrible to have the problems let alone have to worry about whether one will be abandoned. no one should have to go through that

        • Suzi Q 38

          Thanks.

  • Teresa Drummond

    Yep the grass is never greener on the other side of the fence… ime most countries have their failings…

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