Healthcare in the United States

It always shocks me when so many people defend the healthcare system in the United States of America. The idea that one’s health insurance should be tied to one’s employer, thereby putting all decision-making in the hands of that employer, who is very rarely putting the needs of its employees over the company’s bottom line. This practice is defended by so many that I cannot help but wonder if they have ever had health insurance that their employer did not provide. Or can it be that all of those people work for companies that put their employees’ healthcare needs over profits?

Among the capitalist ideas of the United States, why is health insurance not something that people are free to choose their own, selecting from numerous plans instead of having one chosen for them? And I do not consider a selection of three or four plans from an employer to be an actual choice — you are still forced to go with the same provider, and you cannot shop around for better prices or better coverage. Why can we choose something as simple as a brand of shoes, but we have limited or no option when it comes to a plan that will affect our health and well-being?

The Affordable Care Act

The Affordable Care Act (ACA for short) was enacted in March 2010. Under this new law, individuals who could not get health insurance through their employer could shop for coverage in a marketplace. Depending on household income, a tax break decreased the health insurance premium for the chosen plan, making even good health insurance affordable to Americans who had no option for coverage through their employer. Though the final Affordable Care Act was not entirely what then-President Obama had hoped it would be, and especially not what others pushing for healthcare reform hoped for, it was a step in the right direction and provided freedom of choice to those who qualified.

Considering the number of employers who only offered part-time work before the labor shortage of the pandemic, it was sometimes hard to find a job that would provide benefits. Many people did not have any health insurance because it was not something they could get through their job, and they certainly could not afford the high premiums without an employer paying part of it. A serious illness could destroy a family, leaving them in debt with massive medical bills that they had no way of paying.

The ACA finally provided an option, yet it was viewed by many as an attack on American values. The idea that people could get affordable health insurance was, and still is, referred to as “socialism.” While the ACA may be based on socialist ideas, the point was to improve the overall health of the people and prevent crippling medical debt. Households would still have to pay for coverage, though at a discounted rate based on income that made it affordable.

Yes, I can hear you now: but that IS socialism. Technically, it is some form of socialism, but is that not a part of our economic structure? The United States is a blend of capitalism and socialism, with emphasis on capitalism and a free market, just not for a handful of goods and services, such as health insurance. Socialism exists in our country, whether people like it or not. Public education, roads, police, and paid firefighters are usually considered socialist programs as they are funded by the tax dollars paid by the community as a whole.

Social Security is another obvious example — it even has the hint in the name, yet most anti-socialist individuals are more than willing to collect their money when they retire. We pay into it with every paycheck, mostly not by choice, but knowing that we will eventually get to pull that money back out, assuming that we live until retirement age. I could go into more detail as to why this is a socialist program, but this is an article about health insurance, not the structure of our economic system.

Where the ACA Fails

I have always been a strong supporter of the Affordable Care Act, though I had mixed opinions on the tax penalty for not having health insurance. On the one hand, the point was for everyone to get coverage. Since opponents would not allow a complete socialist-style Medicare system for everyone, a tax penalty was the best way to persuade individuals that they would be better off taking even just a cheap plan to avoid paying the fee. On the other hand, the United States is supposed to be about freedom, so should we force people to get health insurance? Should it not be up to them if they want to take the risk of massive medical debt from an unforeseen illness or accident? That said, where the plan fails is precisely what the opposition is fighting to protect: freedom of choice.

Suppose you were not eligible for health insurance through your employer, and so you choose an excellent plan using the healthcare marketplace. You enter your estimated income for yourself and your spouse, and you can get a top-tier plan for a monthly premium you can afford. The plan has no deductible, and you will pay $25 for a doctor visit, $50 for a specialist, and $200 for a trip to the emergency room. You have all of that coverage for yourself and your spouse for, let’s say, $200 a month. Sounds good, right?

Now let us fast-forward a year. You are suddenly eligible for coverage through your same employer, but the top-tier plan will cost you $550 a month to cover yourself and your spouse. You make about the same amount of money as before, and now your health insurance will cost $350 more every month. Worse than that, the new plan will not cover as much and has a $1500 deductible per individual/$3000 family deductible for in-network medical care. You cannot afford that much of a monthly payment, so you have to go with the middle plan, which will still be $360 a month and has the same deductible as the more expensive plan, but you will pay more per medical visit.

And therein lies the problem with the ACA: you are forced to take the employer plan because you are no longer eligible for the tax break to help cover your marketplace plan. That excellent $200 a month plan you had before would cost you over $1000 a month to keep it, and all because you worked more hours at your job and are now eligible for benefits. Benefits are supposed to be a good thing, right? So why, in this scenario, does it seem like they are terrible? You now work more to have less money unless you decide to risk it and go without any health insurance. That seems reasonable when you are young, but as the years go on, health insurance becomes a necessity to your health and well-being, both physically and mentally.

Punishment for Dedicated Employees

With the current setup, it is in the best interest for some employees to work less than full-time hours at a job or to work two part-time jobs instead of committing to one employer. While there likely are employers who offer great health insurance plans — I know I had one briefly when working at a local bank — that does not seem to be the case with most employers, especially for lower-paying jobs.

Even when I was a salaried store manager, my health insurance covered nothing until I hit $6000 out-of-pocket, which is not likely to happen for most people in a year. In 2019, I reached that amount after multiple trips to a specialist at about $200 per visit, a minor diagnostic surgery, and a major surgery to remove pre-cancerous growth. I was already paying $220 out of every bi-weekly paycheck for coverage for my husband and myself. On top of our premium, we had to pay expensive medical bills and then had outstanding medical debt that we could not afford because of my surgery.

I fail to understand why this insurance was seen as a great benefit of my employment, especially since I knew I could get a plan through the healthcare marketplace that covered more and would cost the same or less because of our household income. The only helpful health benefit I had was short-term disability for my six weeks of recovery, and even that came with attitude from my boss. The insurance I had at my next job was far superior, costing us only $20 for a doctor visit and $40 for a specialist, and yet the monthly premium was a little lower.

As we get older, we need more medical care, and to be forced to accept an inferior plan from an employer instead of choosing a suitable plan from the marketplace makes no sense. Is that the freedom of choice that so many people claim to desire? To be forced to pay for insurance that will not cover anything, even if you are willing to pay more to get a better plan through the marketplace? It is similar to being forced to pay for service from a lousy internet provider because there are no other options — even though you know there are choices, you are not allowed to make them.

The example I provided earlier about losing good coverage after becoming eligible for benefits is actually true and a perfect example of a broken system. This scenario was precisely what happened when my husband averaged enough hours at his job, a job that was supposed to be part-time. The shock hit worse after I saw the bill for bloodwork, something that cost me nothing under previous plans and $50 under our marketplace plan, but $587 with the insurance we have through his employer. If I were making enough to cover all of the bills, I would have told him to just quit his job before the new health insurance went into effect, letting us keep our old plan. However, due to my own medical issues, I was not in that position, so we were forced to pay more for less, just like so many other Americans.

Change is Needed

Though I desperately hope that someday the United States’ healthcare system will change for the better, I highly doubt that will ever happen. I know one argument against healthcare for all is that the time one must wait to see a doctor will increase. To those people, I ask: where are you going that you are not waiting? I had to wait two months to see a specialist for what turned out to be pre-cancer, something that would have developed into cancer had we not caught it. My husband had to wait even longer than that to see a neurologist for his epilepsy after moving in with me. We have to schedule doctor appointments at least a month in advance, sometimes more than that. Where are you going that you are not waiting to see a doctor?

As great as healthcare for all would be, I will settle for the freedom to choose whether we want to go with an employer plan or keep the tax break for a marketplace plan. As soon as you are eligible for insurance through your employer, you can no longer get the tax break that makes the marketplace plans affordable. You are stuck with whatever your employer deems good enough for you, and if they decide to change it one year, as happened to me just before my pre-cancer diagnosis, tough for you. Your only other option is no insurance, a choice that is not possible if you or a loved one need regular medical treatments or prescription medication.

In a country as developed as ours, and especially in a primarily capitalist economy, why are we still holding onto an old system that does not work for the people? Why do we allow insurance companies and corporations to choose what medical care we can get? To set high deductibles and no coverage or reimbursement until we reach those deductibles? We claim to be a free country, yet we ignore this issue, thinking that it does not affect us.

Until one day it does, and you have to decide if you will pay your rent or keep your health insurance. Or whether you need that medication that your doctor prescribed to you, and can you skip a few meals to pay for it.

We are better than this, America.

This article was originally published on Medium.