HMOs have been around for years and years. The first one I joined, my only insurance choice offered at work, cost me the ability to visit a favorite doctor. The second one, a version of Medicare "with benefits", again limited my choices of whom to see. I've been too lazy, now that I'm out of that one, to hunt up a primary Doc I like better, but as soon as we get back from summer vacation I have one in mind to try.
In the meantime, there were a lot of years without any insurance. I qualified for Medicare before Obamacare took effect. I guess you could say I "aged out" of the program. At any rate, I know what it's like to be without insurance, when that means being without healthcare except for the barest minimum I could afford, and often having to tell my Doc that whatever she recommended just wasn't possible. I would have loved Obamacare. I still do for all those who are getting by on it now.
Yes, I still and will always believe that a single payer system is the best of all possible choices. Try Canada - though right now they try to keep us out because so many uninsured folks sneak across the border for free-to-them healthcare. Yes, even with Obamacare. There's a glitch in our system. It could have been easily righted, if only Republican ideology hadn't worked overtime to ruin the system rather than fix a glitch. And no, you don't have to take my word for it: just learn to read... widely.
Medicare was expanded in many states so that those with limited incomes could get financial support for their healthcare premiums. If you check out the maps of where that happened, and compare it to the red/blue used in denoting politics, you'll find out that mostly red states, with Republican governors and state houses, refused Medicaid expansion even though it wouldn't have cost them a penny. It was, after all, covered by federal funds, money that their own taxpayers had pumped into the system in, say, income taxes. Other taxes too. Hey, why not get your own money back, doing something useful for you? And if you check those same maps, you'll find that the states benefiting from the Medicaid expansion are mostly those colored blue, politically. There are exceptions, nearly all because a few Republican governors considered the welfare of their citizens over their own political futures. Check out Ohio.
It has become the Republican mantra in the last couple of decades that taxes are evil and the richest among us are to be supported rather than asked to pay a bigger share. Corporations are sacrosanct, and tax breaks to lure them into our communities are sound strategy. Somehow we, the people, have disappeared from this value system, though every two or four years pleasing lies are bandied about to lull us back to sleep so we can't see what is happening. Hey, maybe we can get rich too! And Keep It All!
So we swallow the lies rather than working together to fix the glitches in the system. One of the most widely publicized glitches is in the VA healthcare system. There are solutions. Put more money in the system. Spread care out into the private sector when demand overflows capacity. Put better, smarter administrators in charge, ones whose primary objectives are actually serving those veterans who have sacrificed nearly everything protecting us. But that would cost, so we ration care and essentially throw away those whose service has ended.
I can't help thinking if we reinstituted the draft, where every Senators' child and mogul's grandchild were called up to serve, their actual care afterwards might be improved. No exemptions, no deferments, no excuses not to serve. Of course, we might also get fewer stupid wars, so win-win, eh?
But we still come back to that institution, where spending money on healthcare is rationed not by need but by profit, that venerable old HMO. You get the cheapest care, not the best. Anybody with "MD" after their name will do if the price is right and the care is limited. (Hey, what do you call the person who graduates at the bottom of their medical school class? Doctor!) Medicines are dispensed by cost, not efficacy or lack of side effects. Lab tests look for horses even if you are suffering from a zebra. You need permission to see a specialist, and get to sit back and wait however long for an opening.
If you think I'm angry, even though this no longer affects me, let me just tell you about two people I know trying to live - literally live - with the limits of their HMOs. The first is the wife of a former coworker. I hadn't seen him for months, and we finally had time for a chat. He'd taken on a second job, just to pay for his wife's medications. She had lung cancer. A new drug was on the market, and she/they decided to try it. Otherwise she had only a couple months left. At the point of our conversation, it had been over a year, and the tumors had all but disappeared. She was feeling great, optimistic that they might actually beat this monster. The problem was, each pill cost them $90! And insurance refused to cover any of it because they were experimental. So his hours were now so long I don't know how he survived on the lack of sleep. I bumped into him again about a year later and his wife was still thriving. He was looking more than a little ragged, however.
Another friend hasn't been feeling his best lately. His HMO finally allowed him one of those cheap smear-on-the-cardboard tests for colon cancer. No, not even the full colonoscopy. And yes, lest you think he should just have gone out and gotten a whole regimen of diagnostic tests, money is tight enough that some days food is an issue, there is no car nor computer or version thereof that many claim are reasons nobody is actually poor anymore in this country, so get over it. The test came back positive. He can get right in to see the specialist he needs... late next spring!
Yes, this is July.
If you believe in prayer, indulge. His state doesn't appreciate free Medicaid, so he can't even afford what the rest of us think is a given now under Obamacare. A little glitch fix blocked by Republicans could have helped, but we can all see where they're going.
Uhhh, you are awake and paying attention, right?