One of the most maddening things about life in these United States is the way we provide and charge for health care. The cost of medicines and medical procedures is enormous, how they are calculated is completely opaque, and the cost of even the most basic health insurance is beyond the reach of many lower-income Americans, particularly as Congressional Republicans move to gut the Affordable Care Act and Medicaid programs which helps make care halfway affordable.
I got to thinking about this topic once again during the run-up to and post-mortems of the passage of Der Furor's "One Big Beautiful Bill," which pays part of its tax giveaways to the wealthy and big business by imposing new limits on Medicaid in the name of "preventing fraud, waste, and abuse." Depending on how you crunch the numbers, as many as 11 million Americans could lose what little health insurance they already have (but not, of course, until after the midterms and the 2028 general election, at which time the GOP will be able to pin the blame on the Democrats who will be in office trying to clean up the mess).
Now, I'm not on Medicaid, but I am covered by Medicare and Tricare (for military retirees) and I have a good Medicare Advantage plan (Medicare Part C), so at least for the moment, I'm more or less protected from the current mess ... but I'm sure it's coming. Here's a personal example of how I'm thinking about it.
Last month I had surgery to replace my right knee. The total cost of the surgery*, including six in-home visits by a physical therapist, was $28,233.00. My total "co-pays" came to $250.00.
Not bad, eh? But riddle me this, Batman: who paid the remaining $27,983.00?
The answer, of course, is that you and I did, through the taxes we paid that fund Social Security and Medicare, plus the health insurance premiums we pay for our private coverage.
Could I have afforded to pay $28,233.00 out of pocket for my knee surgery? Hardly. But I'm very fortunate to have good health insurance. Many other, less fortunate, Americans would have been ruined by such a bill ... and are, every day.
Another way in which I am fortunate is that, as a military retiree, I am able to get my prescription medications at no cost from military pharmacies. At the moment, I am taking five different, relatively common medications for various ailments. It's all but impossible to calculate how much I would have to pay for these "on the outside," as the cost depends upon type of insurance, the pharmacy used, whether coupons are available, whether the brand-name or generic version is dispensed, the phase of the moon, or whether the manufacturer offers some type of discount for certain patients. As best I can estimate (thank you, Google), the cash cost for a three-month supply of my five meds - were I to have to pay it myself - is about $800, or $3,200 per year. If I needed more exotic medications for other conditions, the cash cost could easily run into the tens of thousands of dollars.
This, if I may comment, is obscene.
It doesn't have to be this way, but it's the way we've allowed it to develop. Medicine has become a commercial commodity in modern America, subject to economic pressures of profit and loss rather than the Hippocratic Oath. Instead of the admonition to "first, do no harm," it is now "first, make a profit."
My personal opinion is that a single-payer national insurance system, augmented by private insurance as desired, would be preferable to the mess we have now. I understand that there are arguments for and against such a system, but the most common one - I don't want faceless government bureaucrats making decisions about my health care, doesn't make a great deal of sense when you consider that under the current system, faceless insurance company bureaucrats actually are making decisions about your health care.
And so are the Republicans who voted for the "Big Beautiful Bill."
Have a good day. Stay healthy - you can't afford not to. More thoughts coming.
Bilbo
*Source: Historical summary of claims provided by my healthcare provider.
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