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writing for godot

Rights and Privileges to Health

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Written by Jaron Pearlman   
Tuesday, 15 April 2014 05:59
One perpetually trending issue in the United States is the looming problem with the 
healthcare system. As the needs of the people diversify, funding, application, 
and participation in sufficient healthcare becomes an ever-daunting task. Essentially 
there have been three basic options for coverage of medical needs:
1.)
Private insurance companies, bought by individuals 
or families with no outside help from a social system.
2.)
Workplace or employer provided insurance, given 
during employment (these plans vary in the amount of people they cover-
families, individuals, ect).
Or
3.)
Federally provided healthcare plans like Medicaid,
 that offer healthcare for those who aren’t employed by a company that provides
 Insurance and can’t afford private care.
Despite these varied options, far too many Americans slip 
through the cracks of being covered. 


Generally speaking the divides are pretty clear. Middle and upper middle class people/families
 tend to opt for private or employer provided insurance. The upper class uses primarily private 
policies, while the lower and lower middle class are supposed to qualify for
 government funded care. In principle this semi-diverse group of options should
 cover most Americans health needs when it’s relevant. But the reality is much darker.

Federal health plans are intended 
to help those below poverty level income, those with disabilities, and the
 elderly. Taxpayers, many of whom do not reap its 
rewards, fund these programs. The current issue with government healthcare programs stems in part from a long 
standing economic recession. This is created by inflation of product prices, devaluing 
of the US dollar, and the thinning American job market. The resulting situation 
is a widening amount of people needing federally backed health plans and a
 dwindling amount of people being able to pay into the system sufficiently-
without becoming lower class themselves. The more people that need government
 plans, the more taxes are needed to cover the cost- kicking back directly onto 
the American people.
As well as this, ‘government funded’ insurance tends to pay
 doctors and medical practices less, often creating a literal loss of profit
 margin (under-reimbursements reaching up to 20%). This forces doctors to
 subsidize their patients with these plans, eventually having to deny coverage for many conditions 
and encouraging less and less to join the American medical practice. Lots of
 doctors have even begun to vacate the country so their private businesses can
 continue to turn a profit. Keep in mind that lots of family doctors are small 
practices, facing real small business struggles that many are familiar with.

Federal funds for insurance are’ borrowed from’ heavily by 
the government itself. Medicare, Medicaid, even social security is stolen from
 regularly and replaced with imaginary numbers in the form of fiat debt. Because
 of this DC has ensured that no social funding even conceivably works at all-
rather it just encourages more government ‘borrowing’ and more federal taxes.
 This isn’t to say social programs are a bad idea, but rather that the creators
 of such programs aim to profit off of them-not for them to necessarily work.

For employer provided insurance there are also major drawbacks. The main one
 was that if an employee were terminated their insurance would be dropped. This
 meant that if an injury prevented someone from working, they would potentially
 be fired and have no coverage. There was an attempt to amend problems like 
these in 1996 under the Health Insurance Portability and Protection Act (HIPPA).
HIPPA more or less required employer insurance to continue until a new policy
 was found by the insured- so long as the premiums were paid. But because of the 
liquid nature of this act, new medical privacy measures were applied to 
employer insurance. These measures continue to make it very difficult for
 doctors to communicate information about conditions, medical needs, and
 treatments to the families and trusted parties of the insured. No medical
 history can be communicated reasonably without threat of legal backlash.
Programs like COBRA are meant to help keep those in transitional situations insured, but often just end up costing even more than the policy did during employment.
Another issue with employer care is the criteria to qualify 
for it. Many part-time workers do not get any sort of work related insurance-
and often it is this demographic that needs it most (especially in a country that is
 seeing more retail and service industry than ever). Single parents/young 
Americans without parental support that are above the poverty line are most at
 risk.
Rising insurance prices also have a dire effect on employee
 health packages. Naturally the costs of insurance are passed onto employees
 through lower wages and higher premiums/deductibles. As the dollar inflates,
 it’s an ever pressing issue to equalize the implications of this upon
 employees.

For small businesses, states have different laws applying to 
insurance mandates. This tends to inhibit the growth of expanding companies,
 and create unfair differences in coverage depending on location in the nation. Larger
 companies have the money to blanket their employees in widely acceptable plans, 
but mid growth businesses are faced with varying legislative demands and (as
 the economy struggles) more employees needing employer insurance. As it stands 
in early 2014, businesses with under 50 employees do not have to provide government
 approved insurance- yet for some reason almost 700 large companies/unions also 
do not. There seems to be an unusual double standard. This leaves a good
 portion of applicable companies right in the middle range, in other words
 ‘developing’.


Private insurance obviously is the most desirable as it covers more medical issues, 
pays doctors well, and (supposedly) can’t/won’t be pulled out from under its 
purchaser (until ACA passed). The catch is notoriously higher premiums (the 
amount one pays for coverage) and deductibles (the amount one has to pay before 
insurance kicks in). Factors like these make the private insurance option only 
available to the relatively affluent. In some places a government funded
 insurance plan can be supplemented with a small private plan- but in the USA 
this isn’t really a fiscally sound option (though this has proven to be a good
 model in some other countries). Those who use private insurers exclusively are also
 still obligated to pay into social insurance programs- from which they will see 
no real return.


The Affordable Care Act (ACA, PPACA, Obamacare) presents the American public
 with the possibility of wider coverage but at several costs that are not discussed 
accurately. To frame the philosophical healthcare dichotomy, the bipartisan system
(which is more or less a monopartisan system) must be referenced.
The philosophy of the argument is whether or not healthcare
 is a privilege or a basic right (these are HUGE generalizations). To conservatives, healthcare should be 
representative of ones standing in the capitalist system. A better job and
 higher income justifies more complete and safer healthcare in the minds of many 
Republicans. Democrats by comparison have the ideal that good healthcare is a
 basic right and should be equally accessible regardless of socio-economic 
standing. The irony is that both philosophies have become means to the same
 end- a homogenization of the lower and middle classes.


The ACA is based off of two basic principles. One is a system of public and
 private exchanges that are regulated by government legislations, mandates,
 and penalties. The other is basically just a massive expansion of Medicaid
(federal) type programs. Most of these industry changes seem aesthetically
 pleasing- including the inability to deny insurance because of pre-existing
 conditions and lower premium/deductible costs for the lower class. To fund this
 influx of federally covered citizens a new series of taxes are being applied.
 The proponents of ACA claim these tax hikes will affect only the upper class, 
but this is a deeply false claim.


The first notable tax is called the ‘Mandate Tax’ and affects those who choose not 
to participate in government exchanges, favoring private ones instead. Besides
 antagonizing free markets in insurance, this helps to ensure that families that 
could afford private insurance will lose money- and likely be forced into
 government sanctioned plans in the future. As a result private premiums and
 deductibles may actually rise further (also due to tax hikes on the private companies 
themselves), and force many insured to drop their coverage. If hypothetically the insurance giants were to go bankrupt because of prolonged customer loss it
 is likely the federal government would bail them out and acquire them at the
 expense of the people (just adding to national debt like in the 2008 investment 
bank bubble).


The next is a universal tax increase for Medicare, targeting household incomes 
of $200,000 per year or more. This is certainly considered ‘upper middle class’
 today, but the problem is that income thresholds for these taxes are not
 indexed- so as fiat currency inflation makes wage amounts go up the affected
 group of people will widen greatly within just a few years. This also creates 
problems for thousands of small business owners that pay business taxes on the
 individual schedule. Ultimately this will be reflected in lower worker pay or employee 
cuts in wage and benefits. This is in addition to the Medicare payroll tax and
 Medicare unearned income tax from investments.


Though it isn’t an official tax, ACA will also remove a significant amount of money
 from Medicare Advantage Plans. These plans are preferred by many of the 
elderly, because of their more comprehensive medical support and relatively low
 price. Because funding is being cut for this, premium and deductible prices
 will rise for MAP participants- potentially leaving many of America’s elders
 uncovered or bankrupt. Many will seek insurance from family members, putting
 additional stress on a struggling generation, or switch to standard Medicare or
 Medicaid which could deny treatment for various conditions.


An additional non official tax is embedded in yet another, seemingly beneficial, 
ACA ploy. The premise of this one is the use of healthcare reform to reign in
 Big Pharma (the unorthodox term for large medical/pharmaceutical companies).
The claim is that ACA will drive medicine prices down, amidst patent expiration 
of ‘blockbuster drugs’ (popular pharmaceuticals), and heightened regulations of
 the companies making them. In the short term this is actually true, and will 
lower profit margins for these notoriously shady companies/lobbies. But within
 the decade the exact opposite will become reality.
What will happen (and what was guaranteed to the Big Pharma 
lobbies by DC) is an increase in government covered citizens by the millions, 
all having to buy directly from the same domestic market which will continue to 
inflate. This creates a certainty that if the ‘goods’ are delivered (as in more 
people needing government care) Big Pharma will see a massive return for their 
patience with ACA before 2020 (over medication of the American people will also contribute to these profits). Also, in exchange for their cooperation, DC has 
promised more regulations for international exchange of pharmaceuticals and
 medical devices- assuring that Americans have little or no choice in the
 offered prices, products, or markets. This discourages healthy economic diversity and puts
 more power in the hands of international companies running monopolies in
 domestic economies. If any sort of proof were necessary, one can look at the
 massive donations to PR funding of Obamacare from Big Pharma lobbies, or the
 revolving door of ACA drafters and Big Pharma employees. It’s eerily
 reminiscent of the prelude to investment banks politically determining their 
own regulations- as they began to post Glass-Steagall (Banking Act of 1933).
 This is an excellent example of neoconservative economics being just as destructive as neoliberal ones.

There are also built in taxes on ACA plans that are silently included in new
 premium prices. These supposedly go to the ACA website and promotion, medical 
trust funds, and general levies for whatever the government wants. While supporters
 say these modest increases will help with premium prices, even more taxes are
 piled on.

Yet another is a hefty tax on medical devices, such as
 prosthetics, implants, and pacemakers. This will cause inflation of these 
product prices which is the exact opposite of increased accessibility. Combine 
this with the increased threshold of medical tax write-offs and ACA starts 
looking a lot like a scam.
In the past, medical expenses in excess of 7.5% of ones 
annual income could be written off as tax-free. Under ACA this jumps to 10%
 costing the public a potential 15 billion over 10 years. This percentage could
 also be raised in the future.


In summation let’s look at the broad facts. For one healthcare needs reform, and 
it is unacceptable that so many holes exist in the system. The GOP and most of
 DC offer no options at all, while the Democrats have given an essential
 band-aid for a flesh wound. It is this writer’s opinion that healthcare is a 
right and should be extended to more people. But that being said, it must not
 be at the cost of the middle class or what little we have of ‘free market’.

When middle and upper class are examined we see a
 discrepancy that lays waste to ACA tax claims. Many people considered ‘upper
 class’ are actually middle class with good home equity. A married couple with a
 worth of one million may seem ‘upper class’, but with equity being tied up this 
isn’t accurate. The true ‘upper class’ in the USA is more accurately branded as
 persons with worth of 9.5 million or more, including Wall Street investment 
traders, CEOs, politicians, or wealthy venture capitalists. That being said,
 the stability and strength of a country can be seen in the presence of its
 middle class. A wise friend of mine once said ‘The true upper class fears the 
middle class because they can relate to the lower class. They also have the 
money to do something about inequality.’

A dwindling middle class is most certainly a road to
 complete corporate/ aristocratic control in the USA. 
As for free market, ACA betrays economic interaction with foreign medicine 
markets while also making small business that much harder to engage in. 
Intentional or not, it is sabotage of the very principle of free market exchange.
 Without diverse economy, and businesses being pitted against one another (with 
reasonable government regulation for accountability ONLY of course), statism is
 unavoidable- a complete meld of corporate and federal monopolies. ACA was 
supposed to encourage competitive insurance rates, but it seems to only do so 
for those under poverty level and at the expense of the medical practitioners. 


No matter the stance on privilege or right, the healthcare crisis is indicative of
 something bigger. This is a widespread failing of economy, government 
function/honesty, currency, and individual attentiveness.
Before healthcare can be accurately addressed the United
 States will have to make very serious decisions and changes. It isn’t just healthcare
 reform that is needed to fix insurance coverage- it is full scale re-evaluation 
of our political process and national involvement with globalization/big business.
 In order to help ourselves and each other we must think about the whole State of our
 Union.
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