Poor and Uninsured in Texas
newyorker.com
newyorker.com
This is insane. Just plain insane. All because he earned almost $200 in disability money above the already low threshold.
But there's one thing that I wish would change - this attitude that a single payer system is the death knell for healthcare. Handing it over to shareholder owned corporations like the ACA did sure hasn't worked out very well. This is one of the areas that I agree with Trump, oddly enough - no more cuts to Medicare, and if we simply can't manage to get a single payer program going, allow existing insurance companies to compete across state lines.
We could start with dental. Appropriate dental care can help prevent a whole bunch of other problems. But the shareholders making decisions? No. That needs to stop.
Random side note: "When they inserted a needle into Oregón’s arm to draw blood, a procedure that, even in a heavily sedated patient, would cause a flinch, he didn’t move"
I'm a Paramedic, and can tell you that the number of people that flinch when I'm starting an IV on them or doing a blood draw is actually pretty low. Sedated or not.
And even in other states that didn’t adopt the expansion, like North Carolina and Missouri, patients like Oregón still have hope of a transplant in a life-or-death situation. That’s because these states allow for a “medically needy” pathway, or a “spend-down” program, whereby patients can meet the Medicaid limit by deducting certain items, including unpaid medical bills, from their income.
In NC at least, these mostly happen not because of the spend-down rule. They happen because we have a public university, with a public hospital, that is supported through the state by the public to provide care for the poor.
I am keenly aware of this. I moved to Norway, which by all means has a lot of social programs. Most of which I am covered by due to my immigration status (marriage). Part of my requirements was to take Norwegian language classes and civics, along with many other immigrants. More than once, medical care was discussed, as it is outside the classroom mostly because folks hear the rumors and get curious if the healthcare system is like they hear.
Looks of shock for not having paid parental leave, which is pretty common in most of the world. And then the shock just seems to keep growing.
For the average person with insurance, however, there are a few perks, so I try to include such things. (Less with the waiting times, for example, and the quality of care if you can access it is fairly good). Still a dire sitution.
All this talk about "disruption". Someone needs to fix this
The people that campaigned for and ultimately defeated the Medicaid expansion in many states should have to spend the rest of their lives without health insurance or proper health care. They are the ones who should be slowly dying and watching as existing cures pass them on by. They are the ones who deserve to suffer for their hate and cruelty.
My friend explained (over many arguments over many months) he simply does not want to pay for anyone's healthcare. He goes to work, and pays his own. He expects others will go to work, and pay their own. End of story. It's that simple for him.
He doesn't even care if paying a little more tax would result in better healthcare for him. He'd rather have shittier healthcare himself than accept paying even a tiny bit for another persons healthcare.
It's completely unacceptable to him that he should have to go to work more (i.e. pay more taxes) to fund someone's healthcare.
I get it. He doesn't care about a "we" society where we all look out for each other and share the wealth and do well, he wants a "me" society, where me does well.
NOTE: Not my views, don't shoot the messenger.
Setting aside the ethics, this attitude doesn't even make sense on its own because very few people actually pay for their own healthcare costs in the U.S., they use insurance through their work, and that is all subsidized by the government anyways because unlike other compensation you get it has a tax break instead of being taxed as your other income.
IMO, it's just a complete takeover of the legislature on this issue by insurance lobbyists and certain sectors of healthcare, but they managed to get the original laws written so that any change looks like some kind of benefit, even though it's already being subsidized, it's just the businesses and insurance companies that get the subsidy and not the tax payer.
The major difference is that his pool is controlled by a company with shareholders who expect to leech off a certain amount of money every month. On the other hand, the government is forcing us to hand money to a private corporation with shareholders that expect to leech off a small amount every month, but the corporation has no say in who gets in the pool.
Single-payer. It's time, dammit.
I live in the South and there's so many people that are so ingrained in the belief that they don't want to pay for other people, that they forget that they could easily lose everything and need a crutch to get back on their feet.
Some insurance companies require employers to sign up a certain percentage of their employees to get the rates they have. Bigger companies often have better plans simply because more people are paying into the system as well. In addition to paying for other folks' care through insurance, he's also paying a premium for his care in part to pay for other people.
In addition, he'd actually work less. If you turned the rates folks pay for health care into a tax, it would make the tax rate fairly high - I dont have numbers, but I'm going to guess it would put it over and above what average tax rates in single-payer nations pay. He'd only really be "paying for himself" in either case. Not to mention the ridiculous out of pocket amounts. 2000-5000 a year deductible is nearly like not having insurance if you are making a low wage because that is a significant portion of your yearly salary.
And the sad portion of all this is that for many folks with such idealism, even showing how it would work on paper isn't enough to change their minds - mostly because it isn't an issue of even what is best for self. It is (sometimes nearly religious) support for an idealism they don't want to give up.
I think that those who work for the government are not participating in captialism, but I have met many who like to complain about those who participate in socialism, and criticize those engaged in capitalism.
It must be nice to be able to say these things while looking forward to a taxpayer funded annuity retirement and planning to enroll in Medicare, even hiring a consultant to maximize the benefits.
Technically he would go to work less (pay less taxes) under a single payer system.
[Not necessarily my own view!]
(Definitely not my view on the matter.)
The other services you listed benefit everyone. Everyone uses police, fire, and military services even if it's not obvious.
No one should wonder why the Waltons are so rich: the interstate system and welfare cover much of their logistics and payroll bill.
And if you think everyone uses police, you've clearly not talked to many black people. Generally speaking, the police won't come in a timely fashion unless you live in certain neighborhoods which break along race lines.
Everyone who doesn't grow all of their own food uses roads, IMO.
We can quibble about what roads we want to focus on and to what extent people use, overuse, or underuse, but the point is different people use the resource to different extents and yet there is a flat tax.
In terms of public health, I wouldn't consider efforts to control communicable diseases to be charity, but that's not the example in the article.
Healthcare is no different. We don't say, "Better get a bucket and some water to go with those bootstraps."
I don't understand how you can be for this but against public health care.
If a business owner or landlord doesn't want their building to burn, wouldn't they install these fire-prevention measures themselves? Wouldn't they invite the fire marshall (or a market-accredited 3rd party fire inspector) on their own? Why do we need Big Government coming in and forcing these measures on owners of private property, at the barrel of a gun, no less?
If you're saying that I benefit because the building I work at, or the store where I buy my groceries from doesn't burn down, don't I similarly benefit if my co-worker or vendor account manager doesn't get hospitalized or die from liver failure? I might not care about them personally, but losing them might hinder my ability to conduct business, as much as my place of work being shuttered due to fire. Or are people much more fungible than buildings?
And they are overridden by any local body e.g. county Fire Marshall. That varies all over the map at the whim of local electorates.
There's just one data point that it would have been good to see... For people who don't qualify for Medicaid, the next step is a heavily subsidized marketplace plan through ACA. Now it isn't an option for people like Oregon after the fact / in this case because getting sick is not a qualifying life event. You would have to do something like move to another state to qualify for special enrollment. But if he had had an ACA plan, the transplant would have been covered, with some very small deductible. I would really liked to have seen the article address how much this would have cost, in monthly premiums and out-of-pocket expenses, because it's a another very "interesting" minefield.
Now, in order to qualify for federal subsidies in the marketplace, you need to make 100%-400% of FPL. If you make less than 100% of FPL you do not get any subsidy whatsoever because the Feds expect you to get Medicaid. This is where states that don't cover people who are making less than 100% FPL can truly fuck someone over.
In this case Oregon was declaring $10,944 of income, or 93% of FPL. An unsubsidized silver plan would then cost ~$252 per month with significant annual out-of-pocket expenses. However if Oregon reported income of $11,800 ($856 more) then he suddenly would have been eligible for a subsidized silver plan for $20 / month with virtual no out-of-pocket expenses. (numbers are from Kaiser's cost calculator for Dallas, Texas)
This income would be so minimal that it would not have disqualiied him for SSDI. You need SGA (Substantial Gainful Activity) of $1,130 per month for that. In other words, he needed to "rent" a room of his house for a few days and report Schedule E income, or have a garage sale and report Schedule D income, or just report $900 of "Other Income" on Line 21 of the 1040 in order to declare the extra income, and thereby qualify for an ACA subsidy.
The ACA was written so as not to expose the Fed to states dumping their Medicaid patients into the marketplace. That's why they have the 100% FPL minimum in order to get any subsidies at all. That makes sense from a Federal policy standpoint, but really drives the point of how badly a state is behaving to not cover people who are under 100% on Medicaid. The "answer" in cases where the number is so close is to make up the necessary income on the tax forms as needed to get the ACA subsidy. And really, at least by my moral compass and theory of civility, you can read make up however you like in this case.
Moving costs money, which he obviously couldn't afford. In addition, not all states will immediately put you on their medicaid because it takes time to establish residency.
He could afford moving from Mexico to Texas when he was 20...