Lessons from a Sore Throat

Lessons from a Sore Throat

News headline: President Obama has a sore throat.

Reactions in the press and on social networking sites are widespread. What seem to be missing from all of the reactions are lessons that we can learn from this story about our healthcare system.

Here is one such reaction. Somebody actually went out of their way to post this on Facebook:

“You notice how much better our politicians TAX PAYER PAID FOR health coverage is? The President has a sore throat he gets a CT scan, a battery of tests, priority treatment! I get a sore throat I can’t get in to see my doctor for three weeks and I have to depend on cough drops…No co pays either! Universal single Payer healthcare for the President, the Congress etc but none fore the people!!!!”

I did not make any of this up or change it in any way. I copied it here exactly the way it was posted.

This is not all that atypical of many reactions. It contains numerous points of misinformation. Unfortunately, we have a lot of misinformed Americans who think this way.

Instead of trying to list the points of misinformation in this quote, so that I can debunk it one point at a time, I’ll start by explaining what kind of health insurance President Obama and members of Congress actually have access to.

All federal employees, including the President, have access to the same health insurance. The only exemption is Congress, and I’ll explain what that is all about. Except for members of Congress, all federal employees use an employer-based system that works similar to the employer-based systems which about 140 million Americans have access to. I had the same federal healthcare when I worked for the U.S. Postal Service. All federal employees, including pseudo-federal postal workers, are in the same boat when it comes to health insurance options. There are no special privileges granted to individuals who happen to have a high government rank, including the President.

The employer-based health insurance available to federal employees is administered through the Federal Employee Health Benefits Program (FEHB). Employees choose from among several plans from various insurance companies. These insurance companies also service private sector employer-based plans. For example, federal employees can choose a health insurance plan from Blue Cross and Blue Shield. In addition to insurance companies, the FEHB program includes insurance plans through labor unions and employee associations. Employees choose which plan they want, and then they have to pay premiums, deductibles, co-pays, etc. – the same as employer-based plans in the private sector. The federal government subsidizes the premiums for these plans as an employee benefit – the same way that employers in the private sector typically do.

In the private sector, employer-based plans typically don’t offer a variety of choices to individual employees. Instead, the employer negotiates with insurance companies, and then agrees to contract for one plan through one insurance company. The federal government is large enough to be able to offer several options to employees. Private-sector employers typically require an exclusive contract for one plan from one insurance company; otherwise they wouldn’t be able to enjoy the cost savings granted to larger pools of employees.

As of 2014, Congress has deliberately excluded itself from the Federal Employee Health Benefits Program. This was done through an amendment pushed by Senator Chuck Grassley (R-IA) in order to match the republican rhetoric (including that of Grassley, who infamously and falsely claimed that Obamacare would create death panels) in opposition to the Affordable Care Act. Instead of explaining to constituents that Congress didn’t have any special privilege over “regular” Americans when it comes to healthcare, and that they weren’t “exempt from Obamacare” any more than any other American with an employer-based health plan, Congress simply passed a law requiring its members to purchase healthcare on federal or state exchanges through the ACA. Members of Congress can go out on their own if they want to, but their amendment allows them to keep the federal subsidies that they enjoyed under FEHB only if they worked through the ACA for their own health insurance. Congress did manage to exempt itself, but not in favor of some special privilege that other Americans cannot access.

The plans available to federal employees are very similar in structure to the plans available to other Americans. There is no free healthcare or other special privileges available to any of them, including President Obama. But there is one important difference which offers important lessons to us about our healthcare system. Will we learn these lessons?

The federal government is able to offer plans with lower costs and higher benefits than many private sector plans are able to offer. In my working career, multiple employers have offered health insurance from Blue Cross. Each one of these Blue Cross plans was different, however. Some of them offered more coverage at a lower cost than others. This is because each plan is negotiated between employer and insurer. Blue Cross and other insurers are able to offer a better deal when the pool of insured persons is larger. It’s all in the economics of healthcare. The larger the pool of insured persons, the less expensive it is for individuals. Have you ever looked at a medical bill or a health insurance statement for a medical procedure? Each procedure is subject to a negotiated price which is cheaper than the price that uninsured people pay. Health care providers are willing to charge less per procedure when insurance companies are able to send more people to them. This negotiated price discount is different for each insurance company. The larger the pool of insured, the lower the cost is for each procedure. Insurance companies negotiate with healthcare providers for lower costs, and they negotiate with employers for more people to get covered in order to get these lower prices offered to them. The more people in the insured pool, the lower the cost.

What does all of this have to do with President Obama’s sore throat? And what lessons can we learn from this about our healthcare system?

This wasn’t simply a common sore throat that President Obama woke up with one day and decided to go to the emergency room. This was something persistent and unexplained, and there was concern that something more serious might be behind the symptoms. The only special treatment that he received was the special treatment that comes from being covered by health insurance. All Americans who are insured get these privileges, as long as they don’t buy subpar insurance plans.

President Obama might be able to afford copayments, but many poor Americans might have been forced to weigh the financial cost of seeking treatment, even if they are covered. However, President Obama’s plan probably cost him less than the plans that many Americans have – not because of any privilege associated with being the president, but because he is a member of a large pool of insured individuals.

It turns out that there likely is something more going on than a common sore throat. It would not have been discovered if he had not sought treatment. This is something that applies to all Americans, and I could provide personal examples. Somebody who was uninsured and couldn’t afford to go to the doctor would not have received a proper diagnosis. Somebody who was underinsured or who had to choose between paying a deductible and feeding their children might not have received a proper diagnosis.

At this point in time, it appears that President Obama’s problem stems from a damaged esophagus. I personally have that same problem, only I didn’t seek treatment in time. My condition became critical before I even received a diagnosis. It is too late for me to have corrective surgery. I have to take multiple medications three times daily for the rest of my life just to counter the worst symptoms. Sometimes, the medication has to be adjusted because it no longer works the same as before. I normally wake up in the middle of the night choking on my own acid reflux. I can no longer sleep in a bed because of this problem. I often get chest pains from this, and the chest pains once fooled cardiologists into prepping me for heart surgery. Only an alert cardiologist who checked my entire medical background was able to get the unnecessary heart surgery stopped just before it started. So yes, this is much more serious than a simple sore throat.

Here are some lessons that we all should learn from this:

  1. Anything that allows more people to be able to afford to seek medical treatment will prevent illness and death. It can also prevent permanent disabilities, lost work, and lost jobs due to lost work.
  2. Subpar insurance plans which don’t cover people when they need it, or make the cost of seeking treatment prohibitive, are preventing people from receiving life-saving treatment. The larger the pool of covered persons, the lower the cost is for everybody.
  3. Employers pay a lot of money subsidizing and administrating health insurance plans. This is a sizable portion of employee compensation. An employer-based healthcare system is the only reason for this expense, which cuts into both company profits and employee wages.

Based on these lessons, we can learn two more:

  1. The ACA is a vast improvement over the previous system. It is able to cover more persons and lower annual cost increases.
  2. A single-payer system would even be much better than the ACA. Lower healthcare costs result from larger pools of insured people, and the entire population of the United States is the largest pool of individuals our country could create.

Healthcare affects everybody. We can choose an attitude of “I’ll go my own way and choose whether to be covered or not, but I don’t want to pay for somebody else’s care”. Or we can choose an attitude of “we are all in this together”, which leads to lower costs, longer lives, less work missed due to illness, less disability, more productivity, more disposable income to grow the economy, and a higher standard of living for all. And it still wouldn’t be a government takeover of the economy. It would be Americans pooling together for a better America.

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Jerry Wyant