All of My Worst Fears - Confirmed

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For the past three days, I've been at the ADAP Advocacy Association (aaa+) Sixth Annual ADAP Conference.  The purpose of this conference is to update attendees on the current state and future of the Ryan White Act and the AIDS Drugs Assistance Program (ADAP), providing vital information about current funding levels, proposed legislative changes, and what advocates can do to ensure that people living with HIV/AIDS receive the care and treatment they both need and deserve.

I should first note that I am not an optimist.  No one who knows me would accuse me of being one, which puts me in the often awkward position of being perceived as being overtly negative.  Either I'm hypercritical of circumstances, or I don't "offer any solutions," this perception is often tendered by people who are either unable or unwilling to look beyond their pie-in-the-sky, eternally frustrating (to me) optimism, and confront the very real issues at play that can literally make or break even the best laid plans.

In my May post, Stuck in the Gay Pride Rut, I discussed Jonah Lehrer's January 2012 piece in the New Yorker, Groupthink - The Brainstorming Myth, in which he addressed the problems inherent to the long-celebrated approach to meetings and planning sessions.  Brainstorming is a business approach lauded for its strict adherence to positivity.  Within the session, no one can deride or question anyone else's idea, because that may frighten less confident people from putting their ideas forth by creating a so-called "negative" environment.

To recap the article, Lehrer discusses research showing that, while brainstorming can often provide a handful of unique ideas, having someone in the room who questions, criticizes, and uses logic to discard ideas that will be largely unfeasible often results not only in more ideas, but in better ideas.  The ideas that come from what brainstorming advocates would consider a "negative" or "adversarial" environment often end up producing better, more quantifiable results than those wherein everyone's ideas, regardless of how stupid or untenable, are considered valid.

What it all boils down to is the basic fact that not every idea is a good idea; not everyone can be a star; not everyone is able to put forth a good idea.  Sorry if that offends some people, but suck it up and deal in reality, not in fantasy.

Furthermore, research indicates that having someone willing to point out problems with ideas often helps to alleviate those issues by forcing others (who are willing to set aside their "You're so negative!" bullshit attitudes) to address them head on, rather than continuing forward with no sort of contingency plan or solution when those problems manifest themselves.

These things having been established, most of the conference, for me, was spent in often abject horror as all of my worst fears about the Affordable Care Act (ACA) were confirmed by presenters who were experts in their respective fields within the healthcare arena.  Every objection I've long expressed to the legislation, all of which have been pooh-poohed by the eternal optimists who insist "Well, this is the best we could do," were validated.  While I certainly enjoy the opportunity to say, "See!  I told you so!" I take no pleasure in being right; rather, I am in no way comforted by my accurate assessments of the ACA, and am honestly not hopeful for the future of healthcare in America.

From the beginning of this long, drawn out saga, I have been disappointed in the legislation that was cobbled together with seemingly little forethought as to the ramifications it may have in the future.  What started out as a promising venture eventually turned

Take, for example, the mandated insurance purchase on behalf of individuals:

The prevailing thought behind this mandate was that, by forcing everyone into the insurance pool, insurance giants would be incentivized to offer drastically lower rates so that everyone could afford coverage.  That sounds like a great idea, but unfortunately for the brainstormers in the room, no one thought to put a Federally mandated premium cap provision (for basic coverage) in place that would control costs.

Anyone who has paid attention to the numbers for the last 35 years will point out that, while inflation and the cost of living have risen exponentially, while average annual incomes (for single-earner households) has remained largely stagnant.  Inflation increased from 1978 to 2013 by 265.48%.

By 2012, households were spending an average of just under $50k/year for annual living expenses.  That's simply ridiculous - it is almost the cost of a single-family home in 1978...total.

So, what is coming down the pipe for individuals looking to purchase health insurance once open enrollment starts in October 2013?  A whole lot of shit.

Insurance companies who choose to raise their rates are going to be subject to review by the Federal government, which, again, sounds great.  Unfortunately for the consumer, that Federal review doesn't mean a goddamned thing, primarily because they have no power whatsoever to penalize companies who are charging their customers an arm and a leg for the most basic coverage.

"But," say the Free Market enthusiasts, "Bringing those exorbitant rates to the attention of the consumer will have a deleterious affect on the insurance companies' reputations, and they will be all but forced to compete for business with each other by lowering prices."

And to that, I respond, "Bullshit."

Insurance companies across the country have enjoyed a largely negative reputation earned for bilking customers and helping to drive up costs for operations that normally cost 1/10 of the price, and despite those negative reputations have yet to reduce their rates, still offer less and less coverage for more and more money, and the consumer is the one getting screwed in the end.  What incentive do they have to lower costs when they have an entire country of people who are being forced to purchase their product?

The answer is, "None."  Basically, it's everyone into the insurance pool, but the insurance companies control the water level.

Furthermore, there are no national standards of coverage set consumers, which means that what one company offers as "basic coverage" is what one company offers as "basic coverage."  The consumer can shop around all they want to find the coverage they desire for the cost they can afford, but what the U.S. needs, as well as healthcare recipients, is a system where they can find the coverage they need for the cost they desire.

There is also no mandate for national implementation.  The reason why every company and provider in the nation are basically stalled is that no one seems to know what's going on with the ACA.  The requirements are unclear, the implementation is unfeasible, and each state is left to their own devices to figure out the rules that both fit their own statewide regulations while simultaneously fulfilling the requirements set at the Federal level.

This problem has basically paralyzed business owners and states because they literally just have no idea what to do.

In speaking with a Republican friend of mine (who conveniently enjoys military healthcare coverage), he argued that he shouldn't have to pay a tax to cover the chain smokers and fat asses who can't take care of themselves.  What he doesn't realize is that, thanks to our current approach to healthcare (which really should be called "sick care"), he's already paying the cost of those people 25 times over.  Were we to simply toss out our current model and switch over to a tax-funded Universal/Single-Payer option - the same kind of healthcare every major industrialized nation in the world current enjoys and manages to afford at a fraction of the cost - the amount he paid in taxes would be far less than what he currently pays for substandard (by comparison) care.

What this boils down to is one of my early points - when we needed a dictatorial approach to crafting healthcare reform, we got a democratic approach which almost always results in a terrible end result.  They brainstormed and got a handful of great ideas (i.e. - ending discrimination based on gender and pre-existing conditions), but along with that came hundreds of really awful ideas.

Forgive me for coming across as "negative," but the stark reality is that we have not one, but several problems on our hands, and no one yet seems able to even begin to formulate an answer.  At this point, all we can do is take an honest look at what we have and identify the problems before they come to fruition.