Tag: health insurance

Blog Posts (64)

March 10, 2017

If Trump Wants to Do Better than Obamacare, He Better Pay Attention to This!

Donald Trump says he can improve upon the Affordable Care Act – promising to get everyone in the country “a much better healthcare plan at much lower cost.” If that’s really what Trump wants to do, he should pay attention … Continue reading

The post If Trump Wants to Do Better than Obamacare, He Better Pay Attention to This! appeared first on PeterUbel.com.

March 9, 2017

The End Of The Affordable Care Act and Its Critics’ Hollow Moral Rhetoric

From the 1940’s to the present, it’s hard to think of a major topic on the American political agenda that has been subjected to more tortured language and ideological extremism than healthcare. By no means am I saying that healthcare proposals to expand access to healthcare over the years should not have been subjected to rational scrutiny and disagreement. But it seems, by and large, disagreement over healthcare policy proposals have always been about the opponents of progressive options to expand insurance coverage tapping into a certain segment of voters’ deepest fears and biases to predispose them against any alternative for change.

All progressive leaders who have attempted reform in healthcare, like Earl Warren (Governor of California from 1943-53) and President Harry Truman (mid-late 1040’s), to President John Kennedy and Lyndon Johnson in the 1960’s, to the Clintons in the 1990’s, to Barack Obama in 2009, have been met with fierce opposition from lobbying groups representing big business, including insurance and pharmaceutical companies, and often physicians through the American Medical Association. The essential line of attack has been that government would become overly involved in medical decision-making and overshadow the influence and judgment of physicians in the care of patients. But to win this argument decisively, the hired consultants devised plans to associate expanded healthcare coverage or universal healthcare with “socialized medicine” and even the “red scare”—clear demeaning associations with undemocratic countries, unlike the United States, that quickly appeal to irrational sentiments and undermine any consensus for reform. These basic underhand, scare tactics continued to be effective against the failed Clinton proposal in 1993 and, later, President Obama’s signature achievement—the Affordable Care Act—which currently in the process of being repealed and radically scaled down in terms of benefits.

It is noteworthy that a trend developed during the Reagan administration in the 1980’s that added ideological vitality to arguments against expanded access to healthcare: not only was any move toward expanded healthcare a move toward socialism, something assumed to be inherently repugnant, but also, that government, compared to free market mechanisms, was particularly inept to bring about any desire change—as Reagan stated in his 1981 inaugural speech. Just as it is not unreasonable to question the viability of various healthcare proposals, it is not unreasonable to question the legitimate and reasonable extent government should be involved in providing public goods and services. But from the outset, Reagan’s critique of government was simultaneously an outcry of how government was providing benefits to undeserving people, like the infamous “welfare queen” who was abusing the system. It’s hard not to discern from his message clear racial overtones that were meant to appeal to crass biases and prejudices of White working people. It became easy to see government services and benefits as “free stuff” that undeserving people received because those who worked were being coerced to support with their tax dollars.

By the 1990’s government was under attack by the political right and when the Clinton healthcare reform effort began to crack in 1993, the opponents pounced. Healthcare reform was not on the public agenda during the Bush administration and many of thought it was a dead issue for at least another generation. However, the election of President Obama revived interest in healthcare reform, which resulted in the passage of the Patient Protection and Affordable Care Act (ACA). In spite of the fact that this bill was developed by Heritage Foundation, a conservative, pro-free market think tank, and implemented rather successfully in Massachusetts by a Republican governor and future Presidential candidate, the political right attacked it from the outset. The passage of the ACA gave right wing media handlers all the talking points they needed to incite public outrage on the part of many White, working Americans, most in need of healthcare coverage, not less.

The ACA was adopted and pushed through by our country’s first African American president, whose success his opponents wanted to subvert, even if they agreed with him. The ACA was predicated on the use of mandates and expanded a Medicaid program, and provided healthcare coverage for many millions of more Americans. Though it used the private insurance market, the ACA was viewed by its strongest opponents, viz. Republicans in the House of Representatives, as a new government, welfare program that provided more free stuff to non-working people on Medicaid; was paid for by those who chose to work; and interfered in the physician-patient relationship, as critic Dr. Tom Price, the new Secretary of Health and Human Services, was wont to say. There were many ways that reasonable people could have made their critiques, but for the Republican Congressional Representatives, the ACA became a bizarre obsession, attempting to repeal without success 60 times. That is, until the unexpected outcome of the 2016 presidential election. Since then, they have been somewhat like the proverbial dog who finally caught the car he had been chasing.

Now the Republicans are in control of the White House and both houses of Congress, and are unwinding of the ACA. Many on the extreme right are eager to see its full repeal in spite of the lack of any clear consensus on the plan for what will replace it and the consequences that will ensue. All along, we have heard promises that the replacement will provide healthcare that is cheaper and better quality care – but so far those promises seem to ring hollow.

At this point the Republican proposal repeals the individual and employer mandates as well as the subsidies based on a sliding scale according to income; the replacement would distribute subsidies based on age, not income, which in effect greatly benefits those in higher income brackets and harms those in lower brackets.

States would allow to cover Medicaid patients using block grants, which would give states broad discretion over how care is provided and greater emphasis would be placed on health savings accounts (which presupposes people have money to save and would only affect the fairly well-off) The new proposal would continue to guarantee that patients with preexisting conditions will not be denied access to healthcare coverage and that children can remain on their parents’ healthcare insurance until age 26.

This proposal will cause many millions of people—ironically many poor people in states that supported the current president like Kentucky and West Virginia—to lose their healthcare coverage. Moreover, with the demise of the ACA there is the real risk that millions of Americans will not only be without healthcare, many more will die unnecessarily.

Let me say again, I fully realize that rational people could disagree about the wisdom of the ACA and which healthcare policy makes the most sense. But attack on the ACA and the insistence on its repeal have been irrational. It is only in the context of a tradition of distorted information, hype, and ideological zealotry that Speaker Paul Ryan could make statements like he did on Twitter on February 21:

Freedom is the ability to buy what you want to fit what you need. Obamacare is Washington telling you what to buy regardless of your needs.”

 It is a moral tragedy that such statements about an essential human service, like healthcare, is even taken seriously by anyone who knows anything about healthcare. All human beings are vulnerable to illness and accidents and when their bodies, or the bodies of those we are caring for, fail acutely, we seek and expect help in hospital emergency rooms.  This expectation will continue and the result will be greatly increased healthcare costs and human suffering, since more people will lose access to primary care and be forced to enter the healthcare system at the acute stage with no insurance, rather than earlier on with medical problems can be more easily managed.

But Ryan’s words also offer a distorted, truncated view of freedom that likely only appeals to the well off with blinkered moral concerns about their fellow human travelers. Freedom for him and his ilk is like saying, “I got mine, let those without fend for themselves; after all, they are free.”  This is a hollow, simplistic view of freedom and our society is paying the price for decades of distorted information about healthcare policy.

We can only hope the fight for universal healthcare continues and eventually a consensus emerges to do the right thing.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.



January 17, 2017

The Future of Health Insurance May Look A Lot Like Our Past

by Craig Klugman, Ph.D.

This week marks the transition of power from President Obama to President-elect Trump. One issue that has been high on Trump’s list of policy changes is a repeal and replace of the Affordable Care Act (a.k.a.…

December 13, 2016

Imminent Threats To Healthcare and Medical Professionalism: We Must Remain Vigilant

In a previous blog I expressed concerns about the possible direction of politics in our country and the risks it poses to the larger procedural, democratic framework, which I take to be essential to the work of contemporary bioethics. Now that the election is over and a new administration is taking shape, I have many grave concerns about the fundamentally new policy directions our nation will be taking. None concern me more than how the planned changes in our healthcare system in the United States and, if they happen, how our most vulnerable patients will be affected. This is because a top agenda for them on day one will be to repeal the Affordable Care Act (ACA), which has provided healthcare coverage for about 21 million more people since its inception in 2009.

The ACA was an imperfect healthcare plan from the start. But after decades of false starts to reform a system that does not have a close second in terms of excessive costs and inefficiencies among industrialized nations, especially in relation to outcomes, in 2009 it was the best option our country had at that time. In spite of some problems in its implementation, due largely to lack of cooperation and critics setting up obstacles, the ACA has become entrenched into our healthcare system. If it is repealed, there will be widespread suffering and chaos. Just recently the nations’ hospital industry “…warned President-elect Donald Trump and congressional leaders on Tuesday that repealing the Affordable Care Act could cost hospitals $165 billion by the middle of the next decade and trigger “an unprecedented public health crisis.”

 The eagerness of the new administration to gut the ACA was affirmed by the appointment of Tom Price, Representative from Georgia who has been a ferocious and over the top critic of this law from its inception. A prominent orthopedic surgeon prior to running for Congress, Dr. Price seems to advocate for a system that is extricated from government as much as possible and placed in the hands of the private insurance companies. His plan, which provides for individual fixed tax credits and health savings accounts and allows insurance companies to cross state lines, may be helpful for many Americans who are relatively well off and have healthcare to start with. But for most of the sickest patient in lower income brackets, these market-based ideas will do nothing to help them and in fact make them worse off. But real world, harmful consequences are the concerns of an ideologue: All that matters is having in place a policy that accords with an ideal vision of how the world should work.

There is no practical way that a purely market based approached to providing access to healthcare to Americans will accomplish the goals of healthcare that the majority of Americans have, which is to provide some type of basic, quality healthcare to all citizens, at an affordable cost. Price’s approach will leave millions of American citizens, many already with serious health problems without access to health except via the emergency rooms. The predictable consequences will be astronomically increasing costs because healthcare will retreat to its pre-ACA days of inefficiency by focusing more on rescuing patients from acute conditions than preventing them from occurring in the first place; and physicians caring for patients with insurance will be doing more and more procedures for which they will be handsomely paid, without improving quality for patients. Which makes it all the sadder to see the American Medical Association (AMA), as it has done at prior critical historical junctures as it did in standing against the passage of Medicare and Medicaid in 1965, endorsing Price’s nomination.

Though Price’s nomination may be bad for patients, it likely represents good news for physicians in terms of their incomes from reimbursement rates. Which is the reason why the AMA supports him and why, in my judgment, it is an abdication of professional, ethical good judgment and responsibility. Their support violates the basic tenant of professionalism as stated in the American College of Physicians (ACP) Ethics Manual that require its members “…to teach and expand, by a code of ethics and a duty of service that put patient care above self-interest, and by the privilege of self-regulation granted by society. Physicians must individually and collectively fulfill the duties of the profession.”

I am heartened by practicing physicians and physicians-in-training who speak out and refuse to be a part of the AMA and its support of Price’s appointment to be Secretary of HHS.  Most notably a petition has gained over 5,000 physicians’ signatures that make it clear “The AMA Does Not Speak For Us”.  As they state in the petition:


“We are practicing physicians who deliver healthcare in hospitals and clinics, in cities and rural towns; we are specialists and generalists, and we care for the poor and the rich, the young and the elderly. We see firsthand the difficulties that Americans face daily in accessing affordable, quality healthcare. We believe that in issuing this statement of support for Dr. Price, the AMA has reneged on a fundamental pledge that we as physicians have taken?—?to protect and advance care for our patients.”


Medical professionalism always exists in relationship to the prevailing economic and political order in society. Because economic and political winds can shift, so can medical professionalism that at times can put it at risk of losing its moral compass. We do not know yet just how strong the head winds will be. But medical professionals and all citizens who care about the future of just and quality healthcare should be especially vigilant in the coming days and remain prepared to show resistance when necessary.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

September 22, 2016

Did You Know That Obamacare Causes Diabetes? Here’s Why It Happens And Why It’s A Good Thing

Obamacare is a big, messy law with so many moving parts, it is often hard to tell how well it’s working. People debate whether it is killing jobs or creating them; they argue about whether it is lowering medical expenses … Continue reading

The post Did You Know That Obamacare Causes Diabetes? Here’s Why It Happens And Why It’s A Good Thing appeared first on PeterUbel.com.

September 9, 2016

Americans Love Their Healthcare But Hate Their Healthcare System — Here’s Why

There’s lots to love about American healthcare. We have some of the best clinicians in the world, as evidenced by the huge number of people who come to the U.S. from other countries when they are sick. Yet the American … Continue reading

The post Americans Love Their Healthcare But Hate Their Healthcare System — Here’s Why appeared first on PeterUbel.com.

August 15, 2016

If You Don’t Have Employer Insurance, You Probably Have a High Deductible

Most people in the United States get health insurance either through their employer or through government programs like Medicare and Medicaid. But some people have to find other ways to get healthcare insurance, with an increasing number of people doing … Continue reading

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August 12, 2016

Your Physician Can’t See You Yet – She’s Busy Filling Out Paperwork!

Left to our own devices, most of us physicians try our best to provide high quality care to our patients. But almost none of us provide perfect care to all of our patients all of the time. In fact, many … Continue reading

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July 27, 2016

New WHO diagnostic labels perpetuate transgender stigma

The movement of the World Health Organization (WHO) to declassify transgender identity as a mental disorder is simultaneously a step forward in affirming the personhood of gender minority individuals, and a step backward in diagnoses that adequately reflect their health … Continue reading
April 13, 2016

Inflation Crawls While Deductibles Sprint Ahead

With increasing frequency, Americans are purchasing health insurance plans that require high out-of-pocket costs. Chief among those costs are deductibles, the amount of money a person or family must spend out-of-pocket on medical care in a year before their health … Continue reading

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