Let?s have some fun with one of the most depressing subjects of the 21st century ? healthcare. Let?s speculate what will replace health insurance after Obamacare blows up.
That?s right, blows up. I realize that?s a chilling scenario, but it?s one we must be prepared for. I think Barack Obama was on the right path in trying to reform healthcare. But given the enormity of the problem, the most he could do was reshuffle the deck.
The one major weak spot in Obamacare, and the one that will likely sink the entire system, is the complete absence of cost-containment. Obamacare did deal with some important aspects of the healthcare system. Those include primarily making coverage available to all Americans, regardless of health status. It also made it impossible for insurance companies to charge higher premiums based on health.
Those changes needed to happen, but Obamacare has mostly been sugarcoated ever since. Healthcare is now eating up nearly 18% of the entire US economy, and it shows no sign of slowing.
How much healthcare is too much healthcare? We?ll find out soon enough, possibly as early as the next financial meltdown.
In the meantime, and while things are on the quiet side, let?s speculate as to what will likely replace it. There?s no way to know for certain, of course, but below are my thoughts.
An Expansion of Medicare or Medicaid when Obamacare Blows Up
I?m listing this one first because there?ll be tremendous political pressure to ?do something?. The most expedient something will be to simply expand on an existing government program.
If we?re lucky, Medicare will be the plan of choice. It?s more generous than Medicaid, and people seem to be generally happier with it. Some sort of quasi-national plan could be implemented that will expand Medicare to non-senior citizens.
It probably won?t be a win-win. Since it?s a government program, taxes will definitely go up. We should also assume it will include monthly premiums, and much higher than what is being charged now. It?ll be an expensive fix.
Another potential negative is that the system will likely be watered down, particularly for people under 65. There?s no way that the US government can turn Medicare into an affordable universal healthcare system. More likely, it?ll be a stripped-down version of the current system, primarily to provide some form of basic-only coverage. We can only speculate what the limitations will be, but rest assured they?ll be there.
Alternatively, the politicians could expand Medicaid. It currently covers a lot more people than Medicare ? 74.4 million ? at a cost of $574 billion dollars (in 2017). Medicare covers 57 million people, at a total program cost of $580 billion (in 2016).
Of course, Medicaid provides minimal coverage, and many health practitioners don?t accept it. It would be better than nothing, but maybe not a whole lot better. And if the program is expanded to the general public, expect to see monthly premiums included.
Whether a public plan involving either Medicare or Medicaid (or both) are implemented, it would take years to happen, and include higher direct costs to consumers.
A Public/Private Hybrid
This combination wouldn?t be without precedent. It?s already employed in other countries, and even in the US through the Medicare/Medicare supplement combination. If we do get some kind of public system, it?s likely to provide minimum coverage. It?ll be up to each of us to get an adequate secondary policy. Since these already exist to go along with Medicare, it would just be a matter of insurance companies expanding policies to younger people.
My suspicion is this will be the ultimate fix, but the transition won?t be painless. Much as was the case with the roll-out of Obamacare, there will be a lot of impassioned political arguments on both sides. And when the dust finally settles, the basic government plan will be both more expensive and less generous than the current models.
Boutique Health Insurance for the Wealthy, a Medicaid Equivalent for Everyone Else
Capitalist systems are adept at providing solutions to most problems. But they tend to work best for those who can most afford them. It?s likely we?ll see some sort of return to a robust private health insurance market. That will enable those who can afford it to get the best kind of coverage available.
It?ll be expensive, but if you?re wealthy, it?ll be the best program available.
It?s likely to coexist with some sort of bare-bones healthcare coverage for the masses, likely built on the Medicaid program. Only once again, the program will be both more expensive and less generous than the current Medicaid set up.
This is probably the ?doomsday scenario? that we have to hope doesn?t happen. But expect something like this to play out if the country goes through a major economic decline. Once again, there will be a strong public groundswell supporting a national plan. But there won?t be money available to make it happen the way we?ll all want.
Private Plans Based on Christian Health Sharing Ministries
As a Bible-believing Christian, part of me is actually rooting for this to take place. However, the current Christian health sharing ministry construct isn?t without its flaws, and isn?t altogether Christ-like either. Still, it can serve as a model for something much bigger in the future.
From what I understand, Christian health sharing ministries are not true insurance. They?re more like a giant IRA, were members make monthly payments into the plan. The funds are then available to the members in their own time of need. The monthly contribution is only a fraction of what you will pay for health insurance on the exchanges.
So far so good.
But here are the negatives:
- Total benefits are capped at lower levels than traditional insurance.
- Qualification is based on the old health insurance system of excluding people with serious health conditions. (This is the part that isn?t at all Christ-like.)
- You have to ascribe to a certain set of beliefs and behaviors in order to participate in a plan.
Put another way, Christian health sharing ministries are extremely exclusive. Not only do you have to be healthy, but you have to be Christian. I don?t have a problem with the faith part of that equation. After all, they are Christian-based. But as a Christian, I have to ask the question how Christian do you have to be in order to be considered Christian? (The jury?s out on that one, even within the faith.)
And of course, the more fundamental problem is that the ministries exclude people with serious health conditions ? the very people who most need coverage.
The Christian Health Sharing Ministry Silver Lining
I don?t want to be too critical of these plans. And I certainly don?t want to ?throw out the baby with the bathwater?. They are, after all, very specific to Christian organizations. As well, the main purpose is to keep member costs low. The only way to do that is to exclude people with the most serious health conditions.
As a private-sector endeavor, these will probably expand once Obamacare blows up. That?s the silver lining. We have to hope that they?ll expand beyond faith, and especially to include the most vulnerable members of society ? the chronically ill.
I believe there?s real potential for Christian health sharing ministries to be the driving private-sector solution to the healthcare crisis. As well, as small, private organizations, these ministries can better control cost, if only because they?re less likely to be ?in bed? with the providers. And my guess is that in a crisis environment, many healthcare providers will anxiously participate in these ministries at greatly reduced cost.
Unfortunately, for these plans to become mainstream and commonplace, the current system will have to fail. It?s ironic but true that failure creates rich soil for forward progress. The current system is so bloated and bureaucratic, that it?s beyond reform.
But when it does finally blow up, all things will be possible. And since the best solutions usually come from the bottom up, Christian health sharing ministries could be the foundation for the way forward in health insurance.
We can dare to hope.
Now that I?ve laid out some possible replacements, let?s consider a couple that I don?t think will happen?
A Return to the Old Health Insurance System
This one seems almost like a slam-dunk, but I somehow doubt we?ll go back to it. I?m guessing the insurance companies would absolutely love to ? which is precisely why the public shouldn?t. Though the system rewarded the young and healthy with lower premiums, it essentially punished the old and the sick.
What?s more, there are solid reasons why it got replaced in the first place, and none of those issues have gone away. The insurance industry spent a lot of money defending the old system, which should make us immediately suspicious. But when it finally disappeared, no one seemed particularly upset.
If we do return to the old health insurance system, we can fully expect the number of uninsured to rise steadily and quickly. My guess is that it will go well beyond the 50 million who were uninsured pre-Obamacare. After all, insurance companies were able to exclude the most vulnerable. And with the rest, they simply charged premiums that made coverage unaffordable.
It didn?t work before, and it won?t work if it?s reimplemented. That doesn?t guarantee it won?t make a comeback, but I seriously doubt it.
What About Universal Health Coverage?
This is probably everybody?s favorite assumed solution, but I don?t share that sentiment. I?ve already laid out the reasons why I don?t think it will work, in 7 Reasons Why Universal Healthcare Won?t Work in the US, but here?s the recap:
- The already high cost base of the US healthcare.
- Strong potential that doctors will exit the field.
- The high cost of malpractice insurance. It?s entirely unlikely America is prepared to give up the right to sue healthcare practitioners.
- The uniquely American pay-any-price mentality.
- Taxes will explode to pay for the new system.
- Any US universal healthcare system will NOT be based on the European or Canadian models. (But rather on a fatally flawed attempt to be all things to all people.)
- Medicare will likely be the model for universal healthcare in the US. That means higher taxes and monthly premiums. No one will be happy with that.
Feel free to suggest universal health coverage, but I just don?t think it will happen.
What are your thoughts? What do you think will replace health insurance after Obamacare blows up?
Whatever type of health insurance program that develops doesn?t need any input by the insurance companies because they are looking at it from the profit end and not the services rendered. The only input I would consider from them is cost of services made transparent.
The main problem of medical services is that we the consumers don?t know what the cost is until after, when we are stuck with the bill. We have to view it like any cash transactions and know what we can afford and if we can have payment options. With health care, there?s no transparency.
This year 2018 will make 2 years that I have been on Medicare, which should remain primarily for seniors so that the services rendered are age appropriate. Unless you have no income traceable by IRS there?s is a cost for Medicare basic coverage up to approximately $400 a month depending on income level. Unless one was on Medicare rolls up to 2015, everyone else pays from minimum of $134 and up. And every time there?s a COLA raise to Social Security, Medicare cost go up in accordance,so in essence no income increase. What I noticed in just the short time period I have been on Medicare is how they decide what they cover for services. I have to see my doctor for appointments every 3 months because of the type of medication I take ( blood pressure and cholesterol) and I noticed that certain costs are completely covered and some are only partially covered which throws what is left into that out of pocket cost to me until I reach a certain amount then they cover 80% of cost.and so on. My problem with this is that I could better deal with my costs if I can factor them into budget before I get billed, which what I am trying to do this year while still paying off last year?s costs. My budget has to include all possibilities because I don?t get raises in pay anymore being retired.
Okay enough on Medicare. A basic uniform healthcare plan for everyone should be an expansion of the Medicaid program which covers basic services ( doctor visits, vaccinations, etc) but covers a wider variety of patients. A part of this would cover children up through their teens, a separate plan for young adults through age 26. After that age, working adults can choose to have basic coverage or add additional coverage per medical need. At all stages, if medical needs are different ( by diagnosis) everyone can get the needed coverage with a increase to premium cost. No one gets totally free service for everything like it is now. That?s part of the problem now as those who get the free healthcare benefits get fuller services than an individual deemed by income of having the ability to pay. We definitely need to eliminate this fraudulent billing which is what insurance companies need to come down on and not rely on having healthy people cover the cost for those who don?t pay while denying claims for services by healthy people when they do need medical services.
Nor should geographic areas preclude cost because everyone?s basic cost should be the same. Also our elected officials have to be on this coverage too and any other extra services they have to pay for out of their pocket not get free healthcare paid by us taxpayers like they do now.
Sorry for being so long winded on this, but to have a reasonable affordable healthcare program, we need to remove the ?free? part idea out of it. If you are on benefits ( whatever the reason) you need to be contributing to costs like everyone else, not making a lifetime commitment to staying on benefits. I am not referring to anyone disabled ( properly and not by fraud) but to those very able-bodied individuals who think working a mere 80 hours a month to receive benefits is hard and think submitting to drug testing is infringing on their rights. Unless you have to take prescribed medication which is monitored by your doctor, other drugs for recreational use are not.
Hi Maria – What you’ve really zeroed in on is the “bubble” that healthcare is in. It’s a classic bubble too. Costs are out of control, transparency is non-existent, benefits are uneven, and some people get disproportionate benefits. It’s not just a classic bubble, but a classic bubble top. We’re at the point of maximum dysfunction, which is usually followed by a collapse. That’s why I wrote this article. I’m not saying a collapse will happen this year or next, but all the symptoms are in place. It could happen at any time. We’re now being asked to believe that the current system can continue on little more than us all having faith that it will. But the problems are noticeably top-heavy, and without solution. What worries me most isn’t so much where we’ll end up, but what will happen between now and a new system. This is a complete wreck that only seems to be getting worse each year.
Kevin, I for one, intend to keep my costs in control by questioning the necessity of every procedure plus asking prior to receiving any services recommended by doctors my insurance to explain exactly what they will cover to avoid surprise bills. I fight every denial of coverage especially when the insurance company told me that they cover procedure. They try to get real picky about correct wording on claims and you have to be stubborn and work with billing to get it worded properly. Luckily for me my daughter got herself in this kind of terminology processing of claims for medical services so she keeps me informed. It has gotten to the point that the notes a doctor transcribes on paper have to be correctly posted into a computer to process claims. It is like learning a new language that keeps changing the meanings of incorrectly used.
We have to be informed about what we need for health care . Granted some of us need more than others but we also need to keep ourselves, healthy. We don?t need a gym membership to be active unless you go there for the social action.
You are right we have to face that changes to healthcare insurance is coming. I get a slightly better service coverage right now with Medicare than I did with the healthcare insurance I had prior but only because the insurance ( which was one of those ?employer-paid? plan, basically a low end bronze plan) I had prior told anyone who was age 60 plus that most services except for yearly annual physical would have to be approved prior to getting any services plus our drug coverage was reduced to $500 total for the year. Vision care and dental care were at designated places. I gave up going to the dentist because that office didn?t retain dentist and every time you went there no one looked at your chart. I lost several teeth because they never looked at my teeth properly plus they used gas when doing any procedures which I couldn?t tolerate.
I am not against using the Medicare style program as a guide to a more affordable healthcare program but not what people think when they are talking about it.
Medicare comes out of a tax fund from payroll tax, it is one of the taxes that comes out of a paycheck that processed even if you have deductions. It is also a program for seniors who no longer work.
Medicaid is a supplement program which was originally to help seniors and widows but was expanded to help mothers with young children. Unfortunately the funds come from the same place Medicare gets its funding.
Our elected officials want to decrease cost coverage for Medicare by passing more cost on to seniors using the idea that we have the spare change available to cover costs.
Like any other age group only the 1% can afford extra costs with no problems. For us on the lower levels of income ( think serfs versus the nobility and the merchants) we have limitations on what we can afford. With minimum wage at least in my state soon to be at $15 an hour, low income will start at around $31,000 yearly which really in this state is barely holding your head above water paying all bills including healthcare.
Healthcare costs need to affordable and the only way I see around it is to insist on transparency of the cost to effectively cause a consumer response. That adage of need causes supply affecting cost has to be turned around. Blind acceptance is over.
There? has to be a way to make it affordable for those of us who pay and want fair equal services.
I think that will come eventually Maria (affordable coverage), but it will be by crisis, and not by a centralized plan. Thus far, those in charge of the centralized systems are concerned only with ensuring sufficient funding for the healthcare circus. Affordability isn’t on their radar screen. As you said, we need to closely scrutinize the care we’re getting and paying for until real reform comes about.
Only in America. This country tries to pretend it’s founded on moral principals, when in fact it is being run by unethical parasites. The US is the only country that basically takes back everything you worked for your entire life. If you own your home and are on Medicaid, the state can and will place a lien on your property. Every other country in the entire world offers free healthcare and retirement with dignity, compliments of the taxes the people paid out their entire life.
BTW, our healthcare and IQ status is ranked far below the countries that somehow manage to provide free healthcare, free retirement, and free or low cost education in return for the people’s taxes; whereas our taxes are being pumped into private institutions and even other countries, for the sole benefit of our oligarchs.
Sorry if I sound harsh, but My friend whose mother who died at home, found out there is a Ohio Medicaid lien on her mother’s house FOR $742,000 plus! They never even told them. They found out trying to sale the home, the only asset their mother owned. The house isn’t worth that amount and Medicaid can bill the family in some cases to recoup THE DIFFERENCE!
Everyone pays for Medicare when they apply at 65. Your monthly cost is based on your income using the five years income rule prior to that age. Those premiums are now $134- $400 a month. And only covers up to 80%, so you then need supplimental insurance that has co pays based on the premiums. The higher the premiums, the lower the co pays. Both are deducted from your Social Security check.
The Obamacare program required all hospitals get the ‘new and improved’ computerized medical record system which increased medical costs. The medical field got greedy too. I couldn’t help but notice everyone working in the medical field wanted more money when they thought Obamacare would cover everything.
I am all for anyone under 18 and over 70 having free healthcare, but apparently our country can’t figure how to do it. I have higher premiums now with higher co pays with less coverage with my same health insurance thru work. Too many young people making minimum wage can not afford healthcare and their families were cut from Medicaid with the increase of the minimum wage.
Oh it is a three ring circus and the ringmaster, keeps announcing the new act. The insurance companies run this country, they even insure our banks! The middle class is bleeding from the whip, trying to keep what they have worked for, a roof over their heads and a little rainy day money. All I see is whatever ‘they’ decide, I will be paying more. Do all you can to stay healthy, and live with less.
Hi Deb – This whole issue gets people’s blood boiling, and I can see it has your’s too. I can’t help but feel that we SHOULD be able to come up with a workable solution, but there are so many vested interests at this feeding trough, that it’s the parasites who are protected. As to the citizenry, we only get lip service. But now that “virtue signaling” is all that seems to matter in America, that seems to be enough. For now. I maintain that reality will come crashing down on us, and only then will meaningful change happen. That’s why I want to open up a discussion on potential alternatives.
Right now, we all know the system is terminally broken, but there’s no consensus as to what would work better. Trump has been saying he’ll dismantle Obamacare, but he hasn’t indicated what he’d replace it with. My sense is he’d like to go back to the previous system. As a wealthy person, it makes sense in his world.
Technically, it may make sense but reality is the insurance companies won’t go for it. They cover less for higher premiums now. It would be nice if we all paid the same price for the same plan, leaving Medicare and Medicaid alone. But that’s a pipe dream. It may sound crazy, but if the bottom falls out, in the long run, things could be changed faster for a better health system, by starting from scratch.
That’s exactly my opinion. The current system can’t be reformed, it’ll resist real reform at every level. Only when the current system blows up will we have any hope of getting something better. We have to be careful though, because it won’t be perfect either. Just – hopefully – less dysfunctional.
When you look at other programs the government has interfered with and/or controlled, does anyone really think they will operate the expansive healthcare system effectively and efficiently? Look at the problems Amtrak and the postal service as examples. I seriously do not believe the government will have the patient’s best interest in mind any more than the insurance companies. Already the regulations are so intrusive that the medical community spends more time filing reports and tapping on their computers than they do in active patient care. I always think of the 10 scariest words…”I’m from the government and I’m here to help you.”
Hi Kathy – You’re right on all counts. Health care’s already a wreck, they’ll make it even worse. And more expensive, we can bank on that. I wish there was a leader somewhere who could articulate a coherent, workable healthcare plan that we could rally around. But it’s one of those things no one wants to touch. Unless he or she promises unlimited care at no cost, the proposal will be dead on arrival.
That’s another reason why I think we won’t get true reform until the current system implodes. People need to embrace a realistic view of what healthcare can do, not the fantasy version. But we live in a “reality optional” society, and it’s not easily overcome.
Well, I guess I’m about to show my ignorance here, but I did not know that Medicare costs, at Age 65, was based on your income the five years prior to that age. I knew there was a cost, but I didn’t know it went back that far or that it was based on your income. But what else would it be based on?? I just didn’t know. I’m not there yet but will be soon. So, it really doesn’t benefit me to earn a higher salary at this point because I’ll just end up paying more for Medicare and also income taxes. I know I sound stupid, but I’m so busy trying to run a business and pay for the healthcare I do have that I don’t have time to think about what I’ll have to pay in a few years. I’m disgusted…with myself and the system…(aka The Matrix…that was me, Kevin!)
Thank you for the Matrix comment Bev, I’m still getting miles out of it 😉 I’m with you, I didn’t realize Medicare had gotten so complicated. What’s bad about the income base is that you might make $80k at age 64, then $30k at 65, but your premium will be based on the pre-retirement income. I mean, if I’m understanding that right. Like you, I’m not looking ahead, not the least of which because everything could change by the time we get there, and our understanding now will be worthless. (I make it a point to limit what I put in my head, due to severely limited space.)
Hi guys, Maria Rose here, I am on Medicare, so let me answer how the Medicare premium is based. Not all of us, just have Social Security as income ( yes Social Security benefits are classified as income). Some people have pensions benefits, which depending on where received from can be equal to or higher than income from working years. (my pensions are much less than my Social Security so I am not so lucky there).
Everyone should apply for Medicare at age 65 and at least get the basic Medicare plan even if they are still working because delaying doing so also increases the premium. From 2015 on, if you were not grandfathered in, (on Medicare prior to that year), premiums were changed from the minimum of $134 to almost $400 depending on your annual income yearly from Social Security, pensions, dividends, retirement income, etc. everything you declare to the IRS when filing taxes. When you are retired and on Social Security, there’s a difference in how you put income on tax form because most of your income is declared on 1099 forms which taxes are taken out differently plus it is labeled differently to IRS. ( I let my accountant figure this out) But we are only allowed $25,000 total of non-taxable income of all income received. Anything over that amount is taxed using the tax charts. So if you have a high-income level (above $85,000) you will pay a higher premium.
This is why Kevin has stressed the importance of lower debt-ratio for retirement because it doesn’t pay (at least tax-wise). If you doubt my words, google Medicare premiums). It was a shock to me to find out I had to pay taxes after retirement because I make over $25,000 yearly with my tiny pensions and Social Security plus having to pay Medicare premiums. I have taxes taken out of everything I receive to ensure that I don’t owe IRS. Also, you will need to check if your state taxes retirement income. I lucked out there. Hope that helps anyone planning for the future in retirement.
As for healthcare insurance, we need to develop a working solution ourselves and we need to do it as a united group because a group has more power than one single individual. I have been following what Amazon is doing by buying/ incorporating a pharmaceutical company to sell prescription drugs. Prescription drugs are a big cost factor in healthcare and we all know how drug companies feel about overcharging us for something that costs them pennies to make.
Maria Rose – I’ve been reading some about that pharmaceutical shift. It isn’t just Amazon. Some large hospitals are looking to create proprietary drug sources, for the exact same reason. An article I read about it suggested pharma companies create artificial scarcity, so as to justify raising prices. The hospitals are saying “enough” and working to secure their own sources. We need more of this kind of boldness, both at the individual and corporate levels.
That’s why I’d like to see an expansion of Christian health sharing ministries. If they could create their own healthcare networks, we could see a major drop in costs, and an end to the cost spiral.
What a great question, Kevin. And, the answer to that question could be immensely valuable to us as we go about our financial planning. In actuality, this question not only applies to Obamacare, but also applies to Social Security, Medicare, and Medicaid. They all have been dragging a wheel in the ditch for quite some time. So, any discussion about Medicare or Medicaid being the solution to Obamacare simply transfers one unsustainable liability to other financially impaired and mismanaged government entities. Therefore, if we can find the answer to your question, we may also find the answer to the failing Social Security, Medicare, and Medicaid programs that are also run by the government.
We believe it was Milton Friedman that said, ?If you put the federal government in charge of the Sahara Desert, in 5 years there’d be a shortage of sand.? We agree wholeheartedly with Friedman’s take on government ineptness and therefore don’t place much confidence in a government solution to the health care and insurance crisis in this country. Others are free to disagree with us and place their bets accordingly.
We equate the health insurance dilemma to the dilemma we face when thinking about heaven. Most everybody wants to go to heaven, but nobody really wants to die to get there. Gettin’ raptured sounds like more fun. And, many seem to be willing to spend a lot of other people’s money to evade the prospect of death and ultimately delay going to heaven. Well, in a similar vein, everybody wants health care and insurance nirvana but nobody really wants to pay for it. They want the other guy to pay for it. Personally, we don’t want to pay for health care and insurance nirvana for ourselves and we certainly don’t want to pay for anyone else’s nirvana.
We doubt there will ever be healthcare and insurance nirvana. The closest thing to healthcare nirvana, at least from our perspective, is that you will pay for the healthcare needs of you and your family and we will pay for the healthcare needs of ourselves and our family whether that be through self-funding or through privately acquired insurance with zero government subsidies. In our view, anything less than that takes us to some degree or another of healthcare hell where the healthy and personally responsible end up paying for the unhealthy and personally irresponsible. In the auto insurance industry model, drivers who present a greater risk of accidents pay higher premiums. If the government did to the auto insurance industry what they’ve done to the health insurance industry, few could afford automobile insurance. Can you imagine towing your uninsured wrecked car (pre-existing condition) to the parking lot of a potential auto insurance company with the intent of forcing them to take you as a client and pay to fix your car? How long would that company last under that kind of business plan? The only way that plan would work, at least temporairily, is through government subsidy. In other words, your neighbor helps pay to fix your car.
We contend that no one has an inherent right to subsidized healthcare or insurance, of any kind. But, not everyone agrees with our position so we concede that at one end of the spectrum there are those who accept personal responsibility for their healthcare and insurance needs and prepare appropriately or those who are at least willing to accept the consequences of their decisions. At the opposite end of the spectrum, there are those who want a socialist nirvana, in some form or another, and want the other guy to pay for it. The problem is sustainability. When the other guy is paying for it we all have a tendency to be a bit more reckless in our shopping. It is much easier to spend other people’s money than it is to spend our own. At some point, the other guy, however, says, enough. We kind of think that is where we are right now, politically speaking. The other guy has had enough.
So, to your question. Our hope is that upon the implosion of Obamacare that it won’t be replaced with anything. That puts the responsibility for health care or insurance needs upon the individual, or charitable organizations, where it belongs. Betting on that outcome is probably the safest approach as we go about our financial planning. It may very well waffle back and forth as the political winds shift from time to time, but that waffling will create a lot of uncertainty in people’s minds and that is not healthy for our minds or bodies. We want to negate uncertainty by being personally responsible for our own outcomes to the maximum degree possible.
Hi Steven and Debra – I wish I could agree with your thoughts, but I think the individual responsibility train left the station a long time ago. No one even gives it much thought. And in a way, where healthcare is concerned that might be necessary. After all, one person may have very little in the way of healthcare costs, while another could be bankrupted. That was true even before health insurance became an accepted commodity. It would be no different post-crash.
My best hope is that we get a private sector solution. Christian health sharing ministries, though far from perfect, look like the model. It’s more organic in nature, and could be even more so when the mainstream system collapses. As you say, no system will be perfect. But we’re in desperate need of something less dysfunctional. I agree that Medicare and Medicaid won’t work, especially after reading Maria Rose’s comment on it. But political expediency may send us down that path as a weigh station on the way to the ultimate destination.
An aside on the rapture…scripture shows an equal possibility that it could be a negative event (if you’re one of the one’s wisked out, it won’t be to Heaven, but the other direction). Devotees of the rapture theory seem to ignore this, as well as the fact that the rapture isn’t part of the basic doctrine. Maybe as you say, it’s a wish to avoid death. I hadn’t thought about that angle, but it sounds plausible.
Hi Kevin. I agree with Steven and Debra on their version of healthcare…i.e, personal responsibility. However, I do see your point about that train having left the station long ago. In an ideal world, we’re all responsible for ourselves, but I don’t see that happening either. I guess I grew up in the world where you worked at a job and your healthcare was provided through an employer, and if you didn’t work, you didn’t have healthcare. It was an incentive to keep your job and to find another quickly if yours was gone. But, since I like to see both sides of an argument, that arrangement kept some people in jobs and places that they disliked intensely. But I don’t think the answer lies in gov’t subsidies because now too many people can artificially lower their income to gain access to that subsidy…in other words, not work and let someone else pay. I think if the subsidy was based on personal assets rather than income, we’d have an entirely different story. But even for the people who do work and have Obamacare, their cost is still not always cheap, but at least they have something. There are no simple answers to complex problems.
Hi Bev – Philosophically, I agree with personal responsibility as being the best course. But what I also meant was that the current system is so steeped in having someone else pay that we now have a resulting unaffordable system that can no longer be afforded on an individual basis. Even if healthcare costs were to come down by 50% it would still be cost prohibitive. By doing nothing we’ve lost too much ground on the easiest solutions. This whole mess is now complicated beyond belief.
I agree that “this whole mess is now complicated beyond belief”. Working in healthcare, and currently with patients on Medicare, as well as dual Medicare and Medicaid, I do not see any type of answer on the horizon. There are unbelievable amounts of profits with insurance companies, pharmaceutical companies. As long as this is the case, and they are able to lobby for their own interests, I, unfortunately, do not see this changing anytime soon. Insurance companies negotiate lower drug prices, then do not pass them onto their patients, the profits are kept in their pockets-in my opinion, and from what I have seen. The huge amount of regulations in the past few years has made it increasingly difficult to actually provide care to patients, versus just having the time to do all the paperwork now required. It is at a ridiculous point. Many providers, from physicians, to nurses, to physical therapists with years of broad knowledge and experience, are leaving, or trying to leave healthcare as it has become such a difficult environment to work in. On a daily basis I am yelled at, cursed at, yes, have patients crying because there is literally nothing I can do to help them in their particular situation. I love my patients, and want nothing more than to be able to help them; however, I now count myself among those that are trying desperately to find a way to retirement, although it probably won’t happen anytime soon. The phrase many of my co-workers use is “I would be so much happier working as a greeter at WalMart, I can’t take much more of this stress”. Forgive me if I sound too negative, this is simply the reality for many working in healthcare these days. A possible solution I do see would be to make healthcare competitive across state lines, this would force the insurance companies to lower costs due to increased competition. As always, thank you for continuing to provide light and focus on these issues!
Hi LA – Your comment is the whole reason I wrote this post and included “Blows Up” in the title. That’s what will have to happen before we start making real progress. I’ve heard it referred to as creative destruction, the process of the old being purged to make room for the new. The problem in our entire economic system is that we have protected industries, just as we have protected classes of people. Old, calcified systems are propped up by official and unofficial policy, so newer and better systems can’t spring up to replace them. It’s all neatly broadcast by a highly controlled media, that does it’s best to conceal that reality that the emperor (The System) has no clothes.
But let me add that the high level of protection the current healthcare system has is evidence that it’s failing and probably close to collapse. After all, if it truly was working, no propping would be needed – Obamacare would never have happened. I’ve seen this described as “systems work, until they don’t”. They last a lot longer than anyone thinks they can, but when they start to collapse, the decline is much faster than anyone expected. It has something to do with human inertia during “normal times”, followed by “rats jumping off a sinking ship” when the end finally hits. As a species, we’re just not rational. But that doesn’t mean we can make dysfunction go away permanently. No matter how entrenched things seem, the history of humanity has been one of rise and fall, purge and regrowth. I think we’re close with healthcare right now, and hopefully a bunch of other systems that aren’t working.
That of course is my optimistic scenario.