Healthcare Deficiencies

May 03, 2017

To the Editor:

Reading last week’s article about Rep. Tom MacArthur’s amendment to Trumpcare (why not call it that?) got me thinking once again about health care. Here are some of my thoughts.

I commend Rep. MacArthur’s attempt to get something done. He is trying to save the pre-existing conditions provision of Obamacare. To satisfy the Freedom Caucus, his amendment would allow states to get a waiver. This waiver would allow states to have plans that exclude pre-existing conditions to reduce premiums if they created a high-risk pool for people denied insurance coverage. The state would subsidize plans for people in the pool to keep premiums affordable. This subsidy would be paid for by either state or federal taxpayers.

The state of Maine had a successful high-risk pool that was subsidized by a tax added to premiums on all healthcare plans.  

In my mind neither Obamacare nor Trumpcare  actually reduces the “direct medical cost.”

Total medical expense equals direct medical cost (payments to hospitals or doctors, etc.) plus overhead (insurance company overhead/profits and state overhead to collect taxes for subsidies).

Since I don’t see any reduction in direct medical cost, having state pools only increases the total medical expense. States would have lots of overhead expenses for employees and political appointees to manage the pools.

I think we forget how insurance works. Insurance works by sharing risk of loss over a large group of people who are paying into a fund that will pay for a loss to one in the group. The larger the group, the greater protection for the insured and the insurance company. If everyone were in one group, pre-existing conditions would not be an issue. Medicare is a good example.

How is it that Europe, Canada, Japan, Cuba and many other countries have very successful universal health care and we, the most successful democracy in the world, can’t figure it out? I have talked to a lot of Canadians. They feel there are some problems with their system, but all of them said they would not want our system.

Joe O’Neill





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