Obamacare, Again

Help me out here (and don’t ask which way I came in….).

Many of my friends tell me the Affordable Care Act (ACA), known better as Obamacare, is terrible, costly, ineffective, and should be repealed.

In today’s (March 29, 2016) Raleigh News & Observer, the paper’s Editorial Board reported the four main criticisms of the ACA were: 1) people wouldn’t sign up, 2) it would “…drive health care costs throught the roof,” 3) it would explode the federal deficit, and 4) it would “…ruin a health care system touted as the world’s finest (though hardly its most accessible).”

The article goes on to point out that a report from the nonpartisan Congressional Budget Office (CBO) concludes the answers are: no, no, no, and no. “It’s true the ACA needs some tweaking and isn’t perfect in some ways. But it is not a failure.”

So – do I believe my friends or the CBO?

Just before the U.S. Supreme Court upheld the ACA a while back, with the unexpected swing vote from the Chief Justice, I wrote my belief that every human being deserves access to decent health care. If we don’t start from that position, that every human being deserves access to decent health care, who cares that due to ACA “Some 22 million more people, says the CBO, will have health coverage this year….”?

As Detective Harry Bosch, one of my all-time favorite fictional crimestoppers (thanks to author Michael Connelly) says:

Either everybody counts or nobody counts.

Surprise Medical Bills

Just read about a woman who had surgery on her thumb to remedy the effects of arthritis that made using her thumbs painful. (“You Only Think You’re Covered,” by Haley Sweetland Edwards, p. 44, TIME, March 14, 2016). The surgery went well; she regained full use of the thumb and went ahead with the same surgery on her other thumb.

She had checked with her health insurance provider before the surgery to ensure the procedure was covered and the providers (surgeon and hospital) were in-network. The first surprise bill for $6,300 didn’t arrive until some time after she had the operation on her other thumb. Now she’s waiting for the second $6,300 surprise bill.

Turns out the anesthesiologist was not in network and the device implanted in her thumbs was not covered.

This morning my wife showed me a report from her health insurance provider listing several tests that had been performed on blood work done by an in-network laboratory. All but two of the tests were listed as in-network and resulted in modest copays. Surprise! The other two were listed as not in-network and carried the full charge. She has yet to receive a bill for this lab work, which was done several weeks ago.

What, if anything, can consumers do about surprise charges that arrive weeks and sometimes months later? I see the following alternatives:

      1. Just pay up and shut up, or…..

      2. Don’t sign the paper they give you that describes the extra charges that might be coming your way. This may delay your health care a while, but might be worth the wait.

      3. Request a list of all of the providers that may be involved in your procedure, preferably before you are wheeled into the operating room and sedated, so you can check to make sure they are all in-network. (Warning: watch out for in-network hospitals that have out-of-network departments.)

      4. Request the make and model of any devices to be used so you can find out whether your insurance will pay for them.

      5. For blood work, request a list of the tests to be performed and showing which are in-network, which are not, and the cost of each.

      6. Get all in-network promises and device approvals in writing, preferably a week or two before you are sedated.

      7. Ask whether there are any “facilities” charges that will not be covered by your health insurance.

      8. If you do all you can to avoid surprise charges and still get a surprise bill, ask for an audit of the coding that produced the charges.

Take action: appeal surprise charges. Complain. Change providers and hospitals. One can hope that at some point hospitals, doctors and insurance companies will some day all feel they are making enough money without hoodwinking their patients and customers, but I’m not holding my breath.

Good grief……

Study the Past….

	A postal inspector in Baltimore noticed fluid leaking from a package addressed to a 
federal judge.  Then he noticed that the fluid had burned a hole in the package.  The 
Baltimore Police Bomb Squad was summoned and the U.S. Department of Justice was 
contacted.
	At the end of the day thirty-four bombs were discovered, addressed to people in 
government and industry whose work involved immigration.
	This all happened almost a hundred years ago, right after World War I, also called 
“The Great War” and “The War To End All Wars,” was over. The U.S. was rife with 
discontent, often violent, aimed at Germans, Russians, Bolsheviks (called “Bolshies”), 
anarchists, people of color – in short, anybody who didn't look or act like “an American” or speak English.
	One of the tragic results of the hatred so rampant in those days was a police strike in Boston.  Two books to read if you'd like to learn more and quite possibly once again 
realize change is never easy or quick: Dennis Lehane's novel “The Given Day” and 
Francis Russel's (non-fiction) “A City In Terror,” both readily available on Amazon 
(e-book or traditional form).
	Compare what is described in those books with what today's “angry voters” have to say. 
	The stone work at the left and right sides at the entrance to our National Archives 
building in Washington read: “Study the Past” and “The Past is Prologue.”