Health Insurance: The Modern-Day "Protection Racket"

So, Florida, North Carolina and a bunch of other red states have managed to thwart the ACA ("obamacare," i.e. "warmed-over romneycare").  I have mixed feelings about that because while I wasn't thrilled with the plan, it would have been nice to be able to get SOME kind of insurance - "just in case."  The unfortunate reality in America today is that you can lose EVERYTHING if you have a major accident or illness and are not insured, and sometimes even if you ARE insured, as my dad found out when despite having both Tricare (military insurance) AND a private insurance policy, my step-mom's [fatal] cancer "treatments" (and I use that term very loosely) ended up bankrupting him because the insurance didn't cover jack sh*t.  That's the practical reality.  

BUT - when you take a step back and look at "health insurance" as a concept, isn't it really just a big "Protection Racket"?!  It's like gambling only in reverse:  You know you can never WIN - that premium money is gone forever no matter how healthy you manage to stay - but you keep paying out the nose for fear that statistically, you MIGHT lose if/when catastrophic illness strikes!  

Having worked in mainstream medicine for over 20 years, I myself avoid doctors like the plague, literally, but I used to have insurance "just in case" back in the early 2000s.  The only way I was able to get covered, being so-called "self employed" (= employee without benefits, working for somebody else but paying the employer's share of the taxes) was simply because CFIDS was not specifically listed as a "condition" on the application for that particular insurance company and apparently they didn't look carefully at my records.  I hardly ever saw a doctor, except to get birth control back when I needed it, but I kept paying, and the premiums kept going up every 6 months until in 2008 they were $400/month!  I just could not do it anymore.  Plus, with the deductible being like $6000+ (and that kept rising, too), it was just insane.  For all practical purposes my "insurance" didn't cover anything, and if/when disaster might strike, the deductible would wipe me out anyway.  After I dropped that insurance I was unable to get covered by any other company for any price, due to my preexisting condition, which by that time all the companies had added to their list of exclusions.

With premiums being so expensive, what are we really paying for, then?  As a (old-school) libertarian, I'm all in favor of "free exchange of goods and services."  But, when you think about it, insurance is neither a "good" nor a "service," it's a gamble.  My doctor used to charge me around $50 for an office visit; I have no idea what they charge nowadays, not having set foot in a doctor's office since early 2008.  At $400/month, that ought to cover like 8 visits - right?  So where is all the $$ going??!!   It's a huge f*ng scam.  But what can you do?  Disaster strikes, people get sick and medical bills can literally take your house.  I don't think there's an easy answer given the existing status quo in our pharma-medical-industrial complex.

A couple of my conservative friends have suggested things like encouraging competition between the insurance companies by allowing people to buy insurance across state lines.  At first that sounds kind of appealing - I would LOVE to be able to get Kaiser insurance again, which I had when I lived in California, it was very affordable and had low co-pays!  Of course that was back in the 1980s.  But, upon looking into this, I learned that "the experts" don't think it would actually solve our existing problems re: preexisting conditions, etc.  In addition, there's the small matter of violating states' rights, because apparently the whole reason it's illegal to buy insurance across state lines is that each state currently has the right to manage insurance as they see fit within their own state, in case anybody cares.  

I do like the idea (in theory) that competition would lower premiums, even though in fact the experts say it probably wouldn't, for most people, given that you need to have ZERO conditions of ANY kind to be considered "healthy" for insurance premium purposes.  My CFIDS had been, thanks to holistic medicine, in complete remission for 12 years when I applied for new insurance; I was a yoga and pilates teacher, a vegetarian, a nonsmoker, with an ideal BMI, taking no medications and not having had any medical claims, ever, but it wasn't good enough, and without regulation to the contrary, it still wouldn't be no matter how much "competition" might ensue; the insurance companies would be "competing" for the young, healthy [men] with spotless medical records.  The rest of us would still be SOL.

Let me just say up front that the ACA technically constitutes "fascism" - the collusion of government and industry.  There's plenty of that going on already in Congress, of course, but the ACA brings it home for the average person.  Basically the government is forcing us to buy private insurance, and then allowing the insurance companies to continue to screw us.  So, they can now screw us with the government's blessing.

Having said that, I would have been ok with everybody just getting on Medicaid.  Because, although the voter card in my wallet says I am a "Libertarian" (a label that makes me cringe now that the Tea Party has coopted it!!!), I really am NOT in favor of, e.g., privatizing the roads.  Of course not!  Have you ever driven in Orlando, Florida?!  THAT is what privatized roads would be like:  A nightmare maze of never-ending toll booths.  I believe there may be some essential services that are in our collective best interest - our "enlightened self-interest," if you will - to be managed publicly: the roads, the military, the prisons, the mail, and maybe even health care, like every other civilized country does.

What?!  Well, yes.  Health care is something that everybody needs at one point or another, especially now that we have the technology to forcibly keep old people "alive" and prolong their misery long after their bodies want to quit, and/or bring little people into the world with horrible deformities requiring ongoing painful, expensive, halfway successful surgeries, whom God and/or Nature would have mercifully taken Home in simpler times.  As technology advances, so does the mandate to use it, like it or not, and so does the cost.  How do we pay for it?!

The problem with "for profit" healthcare is that healthcare by its very nature (at least in our allopathic system) involves taking care of sick people.  And the only way that insurance companies can make a profit, which is their nature in a capitalist system, is to ensure that the intake of premiums $$ is greater than the outflow of benefits $$ paid; therefore, obviously, they want to insure healthy people who don't NEED to use the insurance benefits!  That was, of course, the purpose of the "individual mandate" of the ACA - by expanding the pool of covered persons to include the young and healthy who might otherwise not bother, you could theoretically keep the premiums lower for everyone.  

Except, of course, there's nothing to stop the insurance companies from raising their rates anyway, especially in states like FL and NC who have chosen, for some reason, to forfeit their state's right of Insurance Commissioner being able to regulate premiums.  I have it on good authority that our wonderful governor Rick Scott, whose family enjoys the best healthcare available paid for by us, the humble working citizens, did so merely in order to say "FU" to the President, because apparently political snubs are more important to him than the health of Floridians who are paying his salary.  No big surprise there, I suppose.

I don't know what the answer is, but I will continue my policy of staying the hell away from doctors as much as possible, relying on holistic/herbal medicine which isn't covered by insurance anyway, and just pray to God that nothing really serious or "catastrophic" ever happens that would result in my becoming homeless.  But let's keep in mind that in America, having a home isn't a "right," it is a "privilege" - as some believe that healthcare also should be.  And who am I to argue with them?

Hobby Lobby, Healthcare and Religion

David Green, the founder and CEO of Hobby Lobby Stores, Inc., says in protest of the ACA mandate requiring birth control to be covered by insurance:

“A new government healthcare mandate says that our family business MUST provide what I believe are abortion-causing drugs as part of our health insurance.   Being Christians, we don't pay for drugs that might cause abortions, which means that we don't cover emergency contraception, the morning-after pill or the week-after pill. We believe doing so might end a life after the moment of conception, something that is contrary to our most important beliefs.  It goes against the Biblical principles on which we have run this company since day one.”

Ironically, he quotes James 3:17 in support of his position:  “The wisdom that comes from above is first, pure, then peaceable, gentle, open to reason, full of mercy and good fruit, without uncertainty or insincerity.”

Open to reason?  Full of mercy?  Without uncertainty?  Ok, then let us reason together.

THE RELIGIOUS CONSIDERATIONS

Mr. Green insists that providing health insurance to his employees that covers birth control, which he believes “might end a life after the moment of conception” (and we will address this belief in the next section), violates his religious liberty as a Christian in that it “goes against Biblical principles.”  Which principles are these?

The term “Christian” generally means “a follower of Christ.”  So, what did Christ say about abortion?  Nothing.  However, despite our Founder’s total silence on the issue, anti-choice Christians assert that their position is based on “Biblical principles.”  I have already addressed this assertion in some depth in my previous article, “Is The Bible Pro-Life?”  But, let’s review a few pertinent points. 

First, one might think that this is common knowledge, but just in case it isn’t:  Jesus was a Jew.  Judaism states that a baby is part of its mother until it is halfway born, and begins life as an individual when it takes its first breath – not at the moment of conception.  Because biblically the breath is life, God imparts the soul (which was created before conception) along with the first breath.  But, the status of official “personhood” as such was only awarded to male infants one month after birth.  (It remains unclear to me as to when, or whether, female infants became “persons.”)  While the fetus is valued as a “potential human life,” the Jewish faith does permit abortion for several reasons including the circumstances of the conception (adultery, rape, incest), the age of the woman (under 17 or over 40), and her physical and psychological health, and requires abortion if the mother’s life is in danger.

So, while fundamentalist Christians like Mr. Green believe that life begins at conception and that abortion is murder, their belief has no Biblical basis and would not have been shared by their Jewish Founder.  In addition, this belief is a fairly recent development in modern Christianity, which was only adopted by evangelicals in the early 1980s.  

“without insincerity"

Therefore, Mr. Green’s claim that his objection to birth control coverage by insurance is based on “Christian/Biblical” principles is simply not true.  Be that as it may, let us give him the benefit of the doubt, because he sincerely believes it to be true.  Religious belief is a deeply personal thing, is protected by the Constitution, and cannot legally be subjected to any litmus test for “truth” or even internal consistency.  Mr. Green has a right to his beliefs.

 But, while everyone is entitled to their own religious beliefs, no matter how peculiar, can the same be said about scientific fact?  Let us take a look at the medical facts.

THE MEDICAL SCIENCE

Mr. Green said, “- we don't cover emergency contraception, the morning-after pill or the week-after pill. We believe doing so might end a life after the moment of conception…”  He believes contraceptives might end a life, but do they? 

First, let us address the anti-choice contention that modern science supports their view of a fertilized ovum being a “person” from the moment of conception.  It does not, for the simple reason that science does not concern itself with metaphysical definitions such as “personhood.”

What science can tell us about is the biological mechanics of pregnancy, a subject on which many people apparently are uninformed and/or misinformed.  I have already addressed this at some length in my article, “Biology, Personhood and Human Rights,” and I will not go into great detail here. 

“without uncertainty”  “abortion-causing drugs” ?

Hormonal contraceptives all work by preventing ovulation, and where there is no egg, there can be no conception.  With unprotected sex, fertilization can happen anywhere from 30 minutes (if an egg has already been released and is present in the fallopian tube) or up to 5 days later, if sperm survive and ovulation occurs during that time.  The pill prevents fertilization by fooling the body into thinking it is already pregnant, thereby suppressing ovulation on a monthly basis when taken regularly.  Plan B (the “morning after pill”) prevents fertilization by delaying ovulation when taken the next day.  Ella (the “week after pill”) suppresses ovulation if taken up to 5 days after sex, thereby preventing fertilization.  But, contrary to popular belief, these drugs do not prevent implantation of a fertilized ovum!  If the ovary has already released the egg, and sperm are present, the drugs are completely ineffective and the woman can only pray that the odds will be in her favor and it will fail to implant (which happens approximately 60% of the time under normal circumstances without any intervention).  

It should be noted that even if these drugs did prevent implantation of a fertilized ovum – which the latest science says they don’t – this would not constitute “abortion” per se.  Abortion, whether induced or “spontaneous” (i.e. miscarriage) is the termination of a pregnancy, which technically does not occur until implantation, 7 to 10 days after fertilization.  This is what I learned while training for my medical career back in 1992 and remains the standard medical definition of “pregnancy” despite efforts on the part of the anti-choice movement to change the definitions to better suit their agenda.

So, Mr. Green’s concern that hormonal contraceptives cause abortion is not, in fact, an issue.  Nonetheless, his personal religious convictions, however unfounded they may be in scripture and tradition, remain protected by the Constitution.  So where does that leave in terms of public policy?

THE IMPLICATIONS

Mr. Green and those in his camp say that requiring an employer to provide insurance coverage for contraception violates his religious liberty.  But, what about the religious liberty of the employees?  Why is it ok for the employer to impose his own religious beliefs on the employees?  Is it reasonable that their medical care should depend on their employer’s religion?  It’s hard enough to find a decent job these days; will people now be required to seek employment only with employers who share their religion, in order to obtain healthcare coverage?  And why is it the employer’s business what the employee does with his or her own body, outside of the context of their job?  The adult employee is neither the child nor the slave of the employer, and is able to make his or her own moral decisions according to their own religious beliefs or lack thereof.

“full of mercy and good fruit”

Not to mention, the whole can of worms that religious exemptions to ACA would open in terms of various religions and their views on blood transfusions, organ transplants, tissue/bone grafts/ medicines derived from cows or pigs, vaccinations, or medical interventions of ANY kind, which could have a life or death impact on the insured employee  -  but this is a separate issue.  

Interestingly, I don’t remember the coverage of birth control by insurance ever being an issue prior to the Obama presidency.  In the past, back when I was fortunate enough to have health insurance during the many years that I worked for both Christian and non-Christian companies, birth control was always covered like any other medication.  I don’t recall any employer, including the Christian ones, ever paying the slightest bit of attention as to the details of what was covered; they were only concerned about affordability.  No employer ever asked me if I used birth control.  It would have been an embarrassing, indeed unthinkable, invasion of privacy!  Of course, for me it’s a moot point now, because being self-employed, with a preexisting condition, I am unable to obtain any health insurance, thanks to my state governor refusing to cooperate with the ACA plan as a result of pressure by conservatives like Mr. Green.

As a business owner myself,  while I disagree with Mr. Green, I do sympathize with his concerns.  All of the above – the concerns of employers, as well as the needs of citizens, whether they be employed or unemployed – is a good argument as to why healthcare should not be dependent on the whims of our bosses, the insurance companies, or the governors of our states.  The ACA was a big step in the right direction but as written (if indeed anyone knows what it really says, as Congress admitted they didn’t actually read the whole thing) there is too much wiggle room for the working citizen to get screwed without recourse.  Hopefully this failed experiment will put us on the road to universal single-payer coverage like other civilized countries.