This was another “Duh!” moment I had recently – it has to do with private health insurers eliminating coverage of office visits from their policies as we move into ACA, or “Obamacare.”
ACA instituted requirements for basic care, but they are minimal – certain tests and an annual physical. That part went into effect a couple of years ago. I had coverage through Anthem Blue Cross at that time, and after I got the physical learned that they would not pay for the office visit portion – the majority of the cost of the physical. I questioned them about this, thinking that “annual physical” would naturally include going to a physician’s office. No, they said, read the contract. They do not cover office visits.
In essence, Anthem had converted their policy to hospitalization only. No office visit of any kind was covered, nor were any costs associated with such visits applicable in any way to the policy – they do not count towards out-of-pocket nor deductible, and no co-pay.
It was done in anticipation of ACA, but why?
The essence of capitalism can be summed up in the words “enclosure” and “exclusion.” Enclosure goes back to the feudal times where lords drove people off the land and took it for their own use. Once enclosed, peasants could return, but only to subsist while turning over the fruit of their labor to the feudal lord. Any who wanted to use land for their own benefit without tribute were excluded.
In broader application, enclosure applies to any public commodity or service, in this case, the health care system. The insurance companies are not in the health care business, but have rather are mere rent seekers (sorry, this is Wiki, but accurate):
In public choice theory, rent-seeking is an attempt to obtain economic rent by manipulating the social or political environment in which economic activities occur, rather than by creating new wealth.
Naturally, as soon as enclosure was complete (this went on around us mostly during the 1990’s as for-profit insurers like United and Wellpoint took not-for-profits private, thereby setting conditions by which all had to operate), we began to see exclusion en masse. The concept of “preexisting condition,” a real hazard for insurers, was corrupted to become “anything that might cost us money.” Honest people who merely needed health care, – who were not trying to scam insurers – were excluded from the system in an ice-in-veins calculation. Consequently, we had 50 million uninsured, a good portion merely people who insurers regarded as potentially unprofitable.
ACA supposedly fixed this problem by requiring that insurers cover everyone, but something a little less savory is contained in the bill – rent. Rather than requiring them to insure us, the bill requires us to purchase their insurance policies. Nonetheless, it’s an improvement even if therein contained is a new and stupendous subsidy.
The new insurer attitude about office visits is a manifestation of the enclosure principle. There are tens of millions of people with conditions needing treatment who have been prevented from getting needed care. With the admission of these people inside the gate, there is going to be a rush to see doctors. Anticipating this, the insurers have constructed a new barrier – no office visit coverage.
Of course, given this restriction, people will not visit doctors. What we are seeing is just a new version of the old preexisting condition regime. By definition, rent-seeking insurance companies have to neglect clients to serve investors. They are at odds with their stated mission, but cannot serve two masters. Investors still rule.
Piece of Mindful 
So, after “investing” $180 billion to “bailout” AIG, essentially owning it, why on earth didn’t the federal government simply enter the health insurance market as a competitor to other rent-seeking corporate crime institutions from which no one can escape? Operating AIG, versus owning its stock, and expanding its role and scope, would have forced “private” insurers to adjust or lose market share because of pressure on price and quality from a new player with a better product. You are right, the product is now inferior, and costs more too.
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There are four level of policies in the exchanges: bronze, silver, gold and platinum. Each covers a larger percentage of medical expenses – 60, 70, 80 and 90%. Most people will opt for bronze, of course, as they are already stressed.
Here is the kicker, however: By removing office visits from the policies, they are not counted as medical expenses for the above policies, so that the percentage limits are essentially meaningless.
This is what happens when private corporations write our legislation.
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You said,
“Nonetheless, it’s an improvement even if therein contained is a new and stupendous subsidy”.
How is this an improvement? I missed something. Are you now praising ACA?
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Formerly uninsured people now have access to annual physical and some lab tests and a hospitalization policy. It was a tradeoff where the insurers gave up very little and got a lot, but the uninsured did get a little and are better off.
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Again, this seems like a good thing to you??? Not to me. Sorry, but I’ll take care of myself be FORE I contribute three hundred bucks a month for shit coverage! I can’t help it. I’m stubborn. I’d sooner die than give those bastards in the insurance industry blood money.
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I made no reference to goodness. I think it is the least worst outcome. I merely stated that uninsured people are slightly better off than before, and that insurance companies have reaped a bonanza.
You seem to want to argue. OK. If you refuse to buy insurance, IRS won’t immediately have a way to know this. But they will, some mechanism will be put in place. But it gets better: as it stands, they cannot go after you with threats of liens and draining your bank account on the health insurance penalty, as I understand it from my recent tax conference. It’s not like regular income tax. They don’t have real collection power.
So something bigger is going on. The mandate seems to be a way to subsidize poor people into bad policies, funneling money to the insurance cartel without providing meaningful coverage, but there doesn’t seem to be any real concern that people like you and me buy insurance. They never wanted us anyway.
So insurance companies are our windmill. Tilt away?
[They can collect the penalty by offsetting your refund, so by all means do not let yourself get into a refund-due position. That is their only collection power.]
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There should be NO money changers between you and your doctor.
http://www.twincities.com/ci_22462995/doctors-at-edina-practice-say-direct-pay-cures
This includes your precious government.
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you’re funny. In Previous post I wrote about how there were two threats to corporate power, unions and government, and how NAM set out 90 years ago to convince Americans that each was evil. You’re a good student of NAM, a perfect tool!
Anyway, I like the St. Paul model, and note that they take Medicare but not private insurers. Why?
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Surly out of compassion.
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Unintentional, I’m sure, but one of your most interesting comments.
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Chances are the Medicare patients they continue to care for are long time customers.
Not some street people suffering from knife wounds.
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I agree that our elderly care is very good, and that otherwise our health care system is below world standards.
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