On 21 Dec 2013, at 0:32, From Med-Events

>  Hey Dr. Crippen, isn’t this the equivalent of the Flo insurance you were

> talking about recently? Apparently, it’s not so bad to be able to

> get catastrophic insurance only, as long as it covers Obama’s butt.

Not equivalent as I have had crap insurance polices like “Progressive” and “Safe Auto” explained to me by my State Farm agent. That highly paid huckster from Progressive holds up a “gun” and loudly proclaims the would-be insured can simply name their price to “get insurance for less”.  What she pointedly doesn’t say is that as the gun spits out lower prices, Progressive cuts out anything that might cost them, or pays peanuts for it. So the customer is pretty happy with that deal. They’re “insured” because the popular huckster says so. Once it comes to signing on the dotted line, the “closer” may explain the fine print. Maybe not.

So when “Safe Auto” does it, they “keep you legal for less”. And they do…until you run into the back end of a Porsche with your rusted out 1984 Ford Pickup. If that truck deposits a speck of dust on the back of that Porsche, it’s US$500 for the dealer to flick it off. If the fender is actually dented, it will be somewhere in the range of US$5000 for someone just to look at it. Maybe US$10,000 to actually fix it and probably a complete repaint. So Safe Auto” in keeping you legal for less, will gladly pay up to US$500 for that Porsche injury, and the insured will pick up the rest. The Porsche owner will then sue the insured and set up a court date to garnish his or her wages indefinitely. Sometimes for as much as 25% of wages or more.

Similarly, Garish, loud pitch woman “Flo” is happy to get you in the room looking for “insurance for less” and the “closer” will also explain in not much detail how you’re now “insured”. Then you get unexpectedly get sick or injured and find out you live in the most expensive place in the world, tens of thousands of dollars a day, US$20.00 for a Tylenol tablet to finance those with no “insurance”. Then your spouse reads the plaques on the wall of the attending physician’s, radiologist’s, pathologist’s and emergency department’s wall: “Patients are responsible for all expenses incurred that “insurance rejects”. Junk policies like Progressive pays a small fraction of the invoice or completely ignores some/many expenses or pays a pittance, following which you are financially responsible. The practical difference between being “insured” and “going bare” is academic. If you have a ten-inch hemorrhoid, shrinking it to 5 inches isn’t much help.

Mostly Democrats have been trying to come up with a holistic health care coverage like every other civilized country in the world as far back as LBJ. And of course, Republicans have been trying to trash that idea on a parallel course. Hillary got her head handed to her in 1993. So, come on, give the devil his due. Obama pulled a fairly reasonable plan off, and left to the way it started out, it had a pretty good chance of doing the job.

Obama made at least two very bad tactical mistakes. First mistake was not using the bully pulpit to jam the original plan down congresses throat sideways while instilling the mortal fear of him in all of them, LBJ style. His laid back professorial affect allowed his mortal enemies (the ones he thought would work with him for the good of the country) to dilute the original plan down to it’s present watered down form. Obama had the vision but not the means. And if you read “The True Believer”(Eric Hoffer), it would have been clear that the visionary is never the one to effect the vision. Obama needed henchmen like Rahm, lots of them out there ripping the throats out of his enemy list. The alternative was giving them footholds, which never should have happened. If you’re going to be in charge, then be in charge for better or worse. Let history decide after you’re gone.

His second mistake was not understanding the reality when he assured everyone that they could keep their insurance if they liked it. That applied to me, not much of the rest of the country. I have incredibly good insurance I have no intention of ever dropping for anything. A few years ago my youngest daughter had brain surgery.  I never received a bill for anything but co-pay for office visits. If “Flo” got the bill for that, she’d burst into flames.

Obama thought everyone with health insurance was like me, but in fact there were a TON of “underinsured” out there just quietly languishing, not breaking the surface of visibility until everyone looked a little closer. Obama also correctly built a plan that would assure no one would go broke instantly if they got sick. That isn’t to say they wouldn’t have to pay some out-of-pocket, but it would be affordable. Obama didn’t have any idea that when he forcing them to come up to minimum standards, two things would happen; those paying low rates for junk polices would find out they weren’t “really” covered and they were going to have to pay more for real coverage.

This of course was a perfect opportunity for Fox News to seek out angry talking heads loudly complaining on camera that Obama screwed them out of health insurance by raising the price. Of course, Fox doesn’t mention that they were never actually insured anyway, it was only an illusion.

So, here we are perched on the brink of 2014 and several things are clear. Despite the Republicans making careers of trying, The ACA of 2008 persists and people are signing up.  Those that had/have junk policies are forced to bring them up to the Egyptian Minimum whether they like it or not. Endless blogs complaining about the evils of Obama from lint on his jacket to bad breath are floating around out there bouncing against desensitized ears. In the end, we have the rudiments of some kind of meaningful health care indemnification in place, it isn’t going to be razed and it will grow and evolve into something better.

It is UNACCEPTABLE that we have a huge portion of our population rendered instantly in hopeless debt or financially wiped out if they get sick or injured. NO other civilized country in the world allows that and they all offer some kind of meaningful indemnification for an affordable price. Do the rest of the countries have problems?  Is the care they offer completely free from glitches?  Are there waiting lines for some services? Sure. But everyone gets care and no one goes to the poorhouse if they get sick. We callously ignore a portion of our population and our life expectancy isn’t any better than Portugal’s. UNACCEPTABLE.

So, like it or not, there are some realities in delivering health care and a previously complacent public is finding them out, however harshly. “Insurance” does not and will never cover every dime of every expense. It is in the process of evolving to catastrophic indemnification where the insured participates in risk.  UPMC is evolving there as well, and I feel it in my pocketbook. But I don’t get a bill for US$100,000 for a surgical operation.

Flo will have to get over it and set the magazine in her price gun to reflect the realities, not the dreams. It will be a painful prescription for the public, but they’ll get over it, just like they got over mandatory insurance for motor vehicles and mortgages.