February 22, 2017

Talking ACA

I spent the day talking with several West Virginians who were impacted by the Affordable Care Act. This included someone who received coverage through Medicaid expansion, some who purchased health care on the exchange, and someone who works in a primary care center.

Their experiences varied widely. Based on what I heard now and in the past, it's pretty clear that those who gained coverage through Medicaid expansion (around 200,000 in WV in a typical year) really like it and are grateful for it.

It's a bit more complicated for those who gained coverage by purchasing it on the exchange, some of whom had life-threatening illnesses. Two out of three of the people I spoke with were concerned with premiums and deductibles which increased, often dramatically, even as their incomes stayed the same.

One thing everyone agreed on was that they needed the coverage they had and that repeal of the ACA without a replacement--preferably a better, more affordable one--would only make the situation worse. There was also zero interest in health savings accounts-- mostly because there was little or nothing to put in them.

Lots more on this to come.


Mary Wildfire said...

Well. I am one who got Medicaid thanks to ACA, but have not been motivated to fight for it, partly because I'm ill-inclined to use it. And because it's such a poor solution to the problem, which is not merely the insurance industry's thoroughly illegitimate intrusion into the question of funding--our healthcare system is fracked up from stem to stern. The ACA was a weak response, created by a political system in which whoever pays the most gets to dictate policy. Hence, we couldn't do the obvious thing, which was to follow the extremely well tested and vastly superior single payer model. We couldn't do it because it would have cut the insurance industry, which provides no healthcare, out of a highly profitable market. But that's only the beginning. For medicine to be more affordable, the drug companies would have had to have their racket stopped, in whi8ch they use "intellectual property" to get away with charging sometimes a hundred times their costs for drugs, often drugs for which taxpayers already ponied up most of the research costs. Then there are the hospital and device company rackets, the expectation of our doctors that they should have very high salaries, in part because getting in position as an MD puts them $100,000 in debt. Then there's the distortion in which drug companies fund medical schools so in becomes all about prescribing, and in which science gets distorted by the profit motive so that drugs for wealthy people are prioritized, and variations on profitable drugs are marketed so as to keep the patents in place, leading not only to misallocation of resources but also playing a large part in the public's loss of trust in science. All of this is driving large numbers away from conventional medicine...a good thing, I'd say, but it's too bad we have to bomb our system to save it.

Antipode said...

Medicaid is a single payer system.