i've become incredibly cynical over the last few years, about many things. cynicism is essentially my staple emotion these days. as the shouting over health care reform goes on, i can only continue being cynical.
the reason is the same as ever: there is always a gotcha, and i always get got.
cash for clunkers: the gotcha was that the old car had to be titled to the buyer for a year. i'd had my truck that long, and had a court order giving me possession that was over a year old, and i had an open title, but that wasn't sufficient. gotcha.
medical coverage: you can get medicaid for your kids, but in texas, non-disabled single adults simply don't qualify because we don't believe in public assistance here. it's not income-based anything; if you're an adult and you're not disabled, you're just not eligible. gotcha.
mental health: in texas there is a patchwork of mental health "systems" because we don't actually believe in funding such things. in this case i did eventually get in, but because of their protocols i can't get the medications that would be most helpful, and it took literally months -- which is a long, long time when someone is debilitated by depression -- to actually get an appointment to see an actual doctor. besides that, it's about the most unprofessional office i've ever been in -- my sessions with the doctor get interrupted, sometimes four and five times in a 15 minute session. gotcha.
food stamps. if you don't work enough, you can't get them. if you can't find work, you can't get em. and when you do apply, be ready for a long, long wait. despite federal law requiring that food stamp applications be decided within 30 days of receipt, texas consistently lags. my own appointment for interview is 112 days after application receipt -- and if they want documents, it'll be even longer. meanwhile, they direct you to food pantries. this sad state of affairs, a result of texas's republican legislature's unwillingness to fund services for its citizens, has spawned a class action suit. gotcha.
as i hear debates about co-ops and subsidies based on income, i believe ever more firmly that it'll wind up being the same old song: just like the mccain plan, where you'd get a $5,000 "tax credit" with which to buy health insurance (that costs, on average, $13,000 a year -- where does the other $8000 come from?), there will wind up being some kind of subsidy, but there won't be a corresponding plan that will cost only what the subsidy pays.
if the subsidy is, say, $10,000 per year for a family of four, that still leaves a a deficit of $3,000 to be paid by the family. in 2008 the united states census used a figure of $21,834 as the definition of poverty for a family of four with two adults and two children. for that family, that $3,000 deficit represents almost 14% of their income, or $250 a month.
i don't know anyone living on that kind of income who can afford to shell $250 a month.
what does that mean? even with subsidies, health insurance will still be out of reach for people who, like me, don't qualify for programs like medicaid.
i did some calculation based on the texas health pool rates, which seem to be semi-reflective of private market policies in the state. that $13,000 figure above assumes a group policy. so if we calculate for a family of four -- a man, a woman, a male child and a female child, ages 35, 35, 0-18 and 0-18, none of whom smoke, who live in the Dallas area (it's rated by zip code), we get a grand total of $21,888 a year -- for a $1000 deductible policy that then pays 80% to an out of pocket max of $4,000 not including medication.
the total of premiums and out of pocket limit (again, without buying any meds) is 118% of the income of our family of two adults and two children.
amusing note: the state pool has a 1 year pre-existing condition clause, and acceptance isn't guaranteed. need asthma medication or insulin for your diabetes and haven't had insurance for a while? gotcha.
another amusing note: the pool provides coverage for kidney, pancreas, heart, liver, lung and bone marrow transplants, with a lifetime limit of $300,000. so if all you need is a pancreas or kidney, *AND* nothing goes wrong, you might get lucky. otherwise, you're fucked. gotcha.
the rates i used, by the way, are effective 1 august 2009, and represent a 6.3% increase from the previous rate table. it's amusing to note that the 2008 rate of inflation is 3.8% (so the increase in pool rates appears to be about 180% of inflation, if i did my division correctly); in 2009 it's -2.1% (that's right, negative).
i have seen lots of bluster and lots of promises, and i want to see good things happen. i want to believe.
but do i?