You can't afford my healthcare

posted by Jeff | Saturday, March 25, 2017, 5:51 PM | comments: 0

Healthcare, and the cost of insuring people to have it, sure was the hot conversation last week. The effort to change the law failed, to my surprise, as a combination of not going far enough, and others saying they were looking out for their constituents. What do you know, governing really is more than just being an opposition.

The United States, as you know, spends more on healthcare per capita than any other nation, yet ranks 31st or 43rd in life expectancy, depending on whether you believe the World Health Organization or the United Nations. I'm not here to tell you that there are simple explanations or solutions to this problem, I'm just laying it out as it is. That anyone would be opposed to exploring the reasons or solutions despite these facts strikes me as absurd.

When it comes to politics, this is an area that I'm not even remotely centrist about. I strongly believe that given the extraordinary advancements in science and technology, there is no reason that every human shouldn't have access to proper healthcare. It's just the human thing to do. This is especially true for children, who have no choice about where they are born. I don't understand why wanting to care for other humans is something anyone is morally opposed to.

I was skeptical of the ACA for a lot of reasons, and was bothered by the individual mandate. I came around to that later because, logically, you can't reduce cost without including everyone in the risk pool. The only real flaw in that thinking is that it works better if it's the same risk pool, which is why it only reduced cost for a short time and only for certain insurers. But it did subsidize costs for a lot of people at certain incomes, which I think is a good thing, despite the cost. This is why replacing this subsidization with tax credits struck me as insane: A tax credit is useless if you don't make enough to pay enough taxes. The ACA is imperfect, given my position, only because it didn't go far enough, but the consumer protections should be non-negotiable going forward.

So let's talk about my healthcare. I want to bring this up because I do OK financially, as is the case for most people working in software. My out-of-pocket costs have ranged from about $2,000 per year to a little over $6,000 since I became a parent. There are only three of us. My portion of the insurance cost has ranged from zero (when I worked at Microsoft and they paid for all of it, in 2011) to almost $10k when I was a contractor. And keep in mind, I was looking for the sweet spot between deductible and cost. Most employers pay a portion of your premium, and if you have family, you have to pick up the rest. Ironically, this arrangement was the worst when I actually worked for a health insurance company.

Some of our costs are higher because we've paid quite a bit for therapies for Simon, to counter some of the developmental delays associated with ASD. I don't regret spending that money at all, because it made a difference for him. Yet I'm left wondering how that goes with someone working at $12 an hour. $6k out-of-pocket would be a fourth of their total income, and that's assuming that they're not already paying an enormous amount toward premiums. If they had a child with the same challenges as me, I doubt very much they would get the therapy that my kid did. To me, that's not OK.

I don't know if my healthcare requirements are typical, but it doesn't matter. They could be worse, and involve cancer, major disabilities, etc. The point is that it's largely out of our control, and it's troubling that 40 other countries that spend less have people living longer. As long as we continue to hide behind the ideologies of our red or blue sports teams and not have the conversation, people are going to go without the care that we are capable of giving, and I find that immoral.

I read an interesting op ed from one of the original investors in Amazon, a guy who has his own jet. He made the point that some level of income inequality is to be expected in a capitalist system, otherwise there would be no incentive to work hard. He also said that there's a point where inequality of all kinds, when they get extreme enough, lead to downfalls of governments and societies. History lacks even a single counter example. If he's right, then perhaps this is a good place to start. Healthy people are certainly more likely to contribute to society.

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