NYT article: Brutally frank insider-view of US health insurance and so healthcare industry

Last updated on 27th June 2017

One brutally frank insider-view of US health insurance and so healthcare industry: --snip--, Before Congress Cuts Your Insurance, https://www.nytimes.com/2017/06/23/opinion/obamacare-cancer-pre-existing-conditions.html, 23rd June 2017.

Two sentences from the article: "The problem was never Obamacare. It was uninsured America — people who had been cut out of the system, but who were nonetheless pushing us toward collective bankruptcy."

Ravi: It seems to me that providing medical insurance for all in a country, in this age where medical expenses can be huge for certain illnesses/injuries, is an extraordinarily challenging task for countries with a large population, even if that country is doing well economically.

The article mentions that the US healthcare insurance industry prior to Obamacare was employer-driven. What is becoming clear to me is that for middle-class and poor USA citizens (and non-citizen residents), having a job in the USA is vital for health insurance coverage for themselves and their families! Losing a job not only means that one has to worry about lost income but that one has to also worry about getting another job fast enough so that one can continue to get health insurance WITH PRE-EXISTING DISEASES COVERED!

The article author had a pre-existing problem which indicated that he would need a hip-replacement sometime down the line. Fortunately the author was able to get his hip-replacment done (a US$ 44,000 procedure) while he was covered under health insurance for that problem. The author writes that if he had lost insurance for two months (during the period it was known that he had this problem which would need a hip-replacement down the line), he would have been excluded from health insurance coverage for that problem in future. Given that the author is not rich that would have put the hip-replacement procedure he needed to not be crippled, out of his reach.

I guess what that implies is that if the author had lost his job, and was jobless for some months (say three to six months) and was not able to make payments for his health insurance policy to kept in force, it would have lapsed. Then he would have to get a new health insurance policy where his hip-replacement problem would come under a PRE-EXISTING DISEASE and so would either not have been covered or would need significantly higher premium for coverage.

The author writes that the health insurance industry (and so the healthcare industry) in the USA is like a lottery (for the poor and middle class USA citizens (& residents)). He says that it isn't an industry and that there is a madness to it that can drive people insane (if you allow it).

Hmm. This is perhaps the most frank insider-view with examples to back that view, that I have read about the USA healthcare insurance industry, and so the USA healthcare field which is very dependent on the insurance industry's financial support for it. Of course, Indian healthcare industry is orders of magnitude lower in terms of quantity and quality of medical service rendered to its 1.3 billion citizens. The Indian health insurance industry seems to be much smaller in its coverage of Indian citizens with perhaps the majority, if not the vast majority, of India's citizens NOT having health insurance coverage. The Indian health insurance industry may be focused more on companies and upper middle class and rich people in India.

So India is way, way below USA in terms of quality & quantity of medical care given to citizens. I don't have the numbers to back my statement but I am quite sure that I am right.

But for most USA citizens (& residents) - middle class and poor class - to have a healthcare system like the one described by the author of the article (even if it is a somewhat biased against USA healthcare system article), seems not right. I mean, USA has the biggest economy and the most powerful military in the world. Its healthcare system for its people must be better than what the article describes, and what the article fears can be a more problematic system in future if the proposed new health care act in USA Senate, becomes law.
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Given below are some comments from my Facebook post, https://www.facebook.com/ravi.s.iyer.7/posts/1928173977399170, associated with this blog post:

Ravi S. Iyer wrote (slightly edited):
--Name-snipped--, Do you think the New York Times article linked in this post, is giving a fairly accurate picture? Thanks in advance for your valuable view based on real-life knowledge of such issues in the USA.
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--Name-snipped-- wrote:
I do agree with the NYC article. I think it it is best grasped by understanding the difference between a US health insurance care we have and a US healthcare system we need. Simply put, the costs are so damn high because insurance companies are between the doctor and patient. The majority of healthcare costs now. are administrative. Health insurance companies are of course for profit so the shareholder will always come before the patient; it is an insane way to provide Healthcare which very obviously does not work. Will write more later when I'm at my desktop rather than phone. It is a subject I'm passionate about.
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Ravi S. Iyer wrote (slightly edited):
--Name-snipped--, Thanks for your "starter" comment. Look forward to more detailed comments from you.

Have noted that you agree with the NYT article. That's an important endorsement of that view, for me. Thanks.

Noted the other points you made, especially the issues with having a for-profit health insurance provider between the patient and the doctor.

I have had quite a few discussions on similar issues with for-profit education industry, both in the USA and in India. But in the education field, in both USA and India, you have both public education sector which gets significant level of funding from the government and so are more economical to students & parents, and private for-profit education sector with either zero financial suport from the govt. or limited support via project grants funding to set up labs for research and sometimes for teaching as well.

Quite a few veteran and/or distinguished educationists with whom I had some discussions on this matter were very negative about the long-term bad effects of for-profit education sector, including outright fraud committed on students by making false promises to lure them to enroll and pay high tuition and other fees.

But in India today, private for-profit higher education institutions in professional education areas like engineering and medicine, which charge very high fees but provide quality education (and job placement in case of engineering ed. institutions), is very popular among the upper middle class and upper class. But they are simply out of reach of poor and lower middle class Indians unless they take some very heavy loans which could cripple them for years if not decades.
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--Name-snipped-- wrote:
Just to show how corrupt our government has become, neither the Republicans nor Democrats want a Single Payer system; only Progressives do. Our elected officials and government have become completely addicted to the money flowing from insurance companies and Big Pharma that they must do their bidding and that is to keep it out.

The logic goes that the larger the pool of payers from an large employer, state government, union, etc. the lower the rates and better the coverage. All of them together wouldn't begin to compare to the over 300 million Americans that would be paying into a Single Payer system...so much for that logic. Medical professionals don't want the existing system. Only the insurance companies and Big Pharma do and why would that be? They keep buying off both parties to write legislation to prevent Single Payer but people are finally beginning to wake up to the scam and pushing back.

The Republican plan will very likely fail yet again and that will be a disaster for them and good for the rest of us because the Dems will have to realize that they can't keep up the "incrementalizing" bullshit they been trying to sell liberals.
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Ravi S. Iyer wrote (slightly edited):
Noted your valuable response --name-snipped--. Thanks. About Single Payer I saw the strong argument made by Geoff Ginter against proposed AHCA system, and for single payer, in a May Townhall of Rep. Tom MacArthur in New Jersey, I made a post of it  transcribing most of Ginter's remarks here: http://ravisiyermisc.blogspot.in/2017/06/nyt-video-report-on-health-care-bill.html.
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--Name-snipped-- wrote:
Ravi S. Iyer I saw this a ways back and I've seen many other similar stories.

What does the fact that the Republicans are writing this bill in secrecy behind closed doors and not giving even their own Congressional constituents time to read it let alone do so carefully tell you? It tells you all you need to know really. This is obviously only done when you're trying to hide and sneak something by. Keep this in the proper context that the majority of Americans now support a Single Payer system. This tell you that they don't care what the majority of Americans or even what their constituents want; they want what serves them personally. If their is another reason this is being done like this I'd like to know what it is.
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Ravi S. Iyer wrote (slightly edited):
--Name-snipped--, There seems to be a BIG disconnect between the majority of USA citizens' need in terms of health insurance and healthcare and what is being proposed in USA Congress. This is very sad. Another big issue is that once such a bill becomes law it may take years to repeal and replace it!
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--Name-snipped-- wrote:
I don't think bill this will pass for the same reason their previous one didn't and every time these fails it is a huge defeat for the Republicans and greatly damages them.

They may be so desperate to that they might even cave in for Single Payer even though they have been vehemently against for decades. They would probably make a few changes in hopes of rebranding it as a Republican idea. Watch for Bernie to start leading the charge on SP soon.
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Ravi S. Iyer wrote (slightly edited):
Noted your response --name-snipped--. Thanks. I follow Bernie Sanders on Facebook and heard his recent Senate speech (after CBO score was provided for Senate bill).
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[Note that the exchange snippet below has only my comments and not the other person's comments. So reader may find reading it somewhat disjointed. Readers are free to ignore the comments below or see the full exchange on my Facebook post mentioned earlier.]

Ravi S. Iyer wrote (slightly edited)
Thanks for your comment sister --name-snipped-- (btw please don't refer to me as sir; Mr. or brother or nothing will do fine).

I think the issue is funding! USA debt to GDP ratio according to some calculations is over 100% (see https://tradingeconomics.com/united-states/government-debt-to-gdp)! That's quite a scary figure even though USA is a very big economy (biggest in the world).

The 2007-08 USA (and then global) financial crisis was TERRIFYING!!! Nobody wants a repeat of that. I believe that healthcare expenses for the poor in the USA are a significant part of USA current and future debt.

But then there are others like USA Senator Bernie Sanders who argue that good healthcare to every USA citizen is a doable thing (without significantly impacting the economy negatively). However, USA citizens voted in the Republicans to power who do not share Sen. Sanders view on this matter.
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Ravi S. Iyer wrote (slightly edited)
Noted your views, sister --name-snipped--.

Regarding Sathya Sai standing for free medical care for all ... Bhagavan has set an extraordinary example by setting up free medical care institutions including sophisticated tertiary care "super" hospitals. That even after his Mahasamadhi these free medical care institutions continue to function is wonderful and one must be thankful to the top-level administration of Sri Sathya Sai Central Trust, the employees, the (free service) volunteers and the donors for ensuring that Bhagavan's legacy to humanity of free medical service institutions continues to shine.

I think these institutions are a superb example for others to follow.

However, I am not sure whether Bhagavan asked Indian state and union/federal government to provide similar services to all Indian citizens. Perhaps he did citing his medical service institutions as an example. I don't know.

I personally am not sure that any plan to provide sophisticated medical care to all Indian citizens free of charge, would work. So I would not back such schemes unless the government provided details of how it will manage the funding of such an extraordinarily ambitious plan (for 1.3 billion citizens of India).

I have seen how poor financial management in decades prior to early 1990s brought India to a perilous financial state in early 1990s where India had to pledge gold with the IMF for badly needed loans to meet necessities. Then finance minister Manmohan Singh under Prime Minister Narasimha Rao (both of whom have visited and got blessings from Swami; perhaps Manmohan Singh came to Prasanthi Nilayam after he became PM) brought in economic liberalization which got India out of that financial mess.

I certainly would not want India to get back into early 1990s kind of financial mess due to over ambitious welfare schemes which do not have proper sources of funds.

However, I do understand that others may hold a different view, and I respect their different viewpoint.
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[I thank nytimes.com and have presumed that they will not have any objections to me sharing the above two-sentence extract from their article, and other references to their article, on this post which is freely viewable by all, and does not have any financial profit motive whatsoever.]