Affordable Care Act and Our Choices

The Affordable Care Act is among the most polarizing pieces of legislation ever created.

It was upheld in June by the Supreme Court in a 5-4 decision, and the buzz surrounding what it means to politics, law, and the individual was deafening.

If it continues to exist as law after this November’s elections and subsequent presidency, I have no doubt that it will change the way we interact with the health care system. Whether it’s for better or for worse is the main subject of debate, but I have a slightly different take on the matter.

We Are Lucky, But…

To a large extent, our family is fortunate. Sure, we have our share of “pre-existing conditions” and problems with getting insurance, but we have no major and ongoing medical problems to speak of. I can’t pretend to put myself in the shoes of someone not so fortunate and think of how I would vote.

We have three private health insurance policies in the family that we pay for completely out-of-pocket and which consume nearly 25% of our income every month. Most of them also require us to further contribute to our medical expenses, driving up the percentage even further.

For the most part, I’m also the sole income earner in the family, and I know that if I was making half of what I do today, our health expenses would exceed 50% of our take-home pay. They would be realistically unmanageable.

I can understand to a large extent what it means to spend a lot on health, even though we will probably never experience the kind of devastation that comes with going bankrupt because of medical bills.

Though politically and philosophically, I don’t support the law as written, I also understand that the current system in this country is neither sustainable nor is it necessarily “fair” for many families who are in our position, or worse.

Health Care will become More Expensive

Whether you accept the current system or you calculate the cost of the new law, or even if you come up with some other third alternative, health care is bound to become more expensive over time. That’s a reality that I don’t think we can escape.

While it might matter for questions of policy, politics, and social structure, our wallets don’t care if it comes in the form of taxes, penalties, premiums, hospital charges, or some other bill. It’s still money coming out of our pockets.

On an individual level, our costs for premiums and care itself will rise simply as a result of aging.

So realistically, what are we to do? I think we focus less on insuring ourselves and more on health. 

The Components of Health

When you really think about, health is one part genes, one part luck, and one part lifestyle.

  • You can’t change genes, since you’re born with them and they pre-dispose you to all kinds of fun diseases and conditions.
  • You can’t change luck–we are all prone to freak accidents, and other diseases are as much environmental as they are a factor of percentages and a simple roll of the dice.

The only thing we can control is lifestyle, and that primarily means taking care of ourselves through diet, exercise, stress relief, and education.

With more effort, you can even start to erode away at genes and luck. Many experts acknowledge that a healthy environment and good lifestyle choices can squash genetic conditions that would have otherwise surfaced. With a stronger immune system, you can avoid catching that flu bug going around that would have otherwise infected you.

You can drive defensively to avoid most accidents. It is also possible to avoid or delay cancers by making certain choices throughout your life, though for many cancers, what those choices are remains a debate.

What’s my point?

The best way to avoid future health care spending is taking care of yourself.

You can’t change luck and genes completely. People will still get hit by cars and get cancer and catch the flu.

The thing is…most of us are sick or dying from lifestyle choices, not these horrible but many times uncontrollable diseases. We’ll still be paying insurance premiums for the foreseeable future. But those premiums don’t have to skyrocket by our account. And we don’t have to pay out of pocket for services if those services are not something we need.

Control what you can, and leave the rest alone. Here’s one more thought…

Human Nature > Political Principles

People debate this law according to their political and personal ideology, but their emotional and personal reaction is usually based on one simple question:

How will this law affect ME?

It’s human nature at its best, and particularly true in this case because health care is not only personal but expensive, sometimes prohibitively so. Anything that promises to save this kind of money, or to provide critical care where it couldn’t be afforded, is going to be very popular with those who need it.

Consider the responses I got when I posed the question on Twitter a few months ago:

@PattyOnMoney said:

As a middle-class woman insured through my employer, it won’t affect me greatly. I may reap benefits such as not being overcharged for my pre-existing condition, and getting women’s care at lower cost. However, my mom on medicare will finally afford her medications for her renal failure until she’s lucky enough to get a kidney transplant. So you can say I’m greateful for the outcome.

Notice that we don’t really know whether Patty agrees with the law in principle, but only how it stands to affect her. That’s a common and completely natural reaction with most of the people I talk to about it.

The two questions I think we need to ask ourselves are:

  1. Do I believe that this law will improve the delivery and affordability of health care in this country?
  2. Is this belief based on my personal stake or an objective evaluation?

The problem is that I don’t think you can even shed #2, no matter how hard you try. My gut feeling is that you’ll make the decision based on what you stand to gain or lose, unless you possess some kind of extraordinary objectivity.

For better or worse, this will be a highly individual decision…

2 thoughts on “Affordable Care Act and Our Choices

  1. I wholeheartedly agree with most of your post, and thank you for not taking a political position on the Health Care Law. Such positions, whether “fer it or agin it,” obscure sensible discussions of the issue. In expanding upon your point regarding lifestyle choices, there is a growing body of evidence that dietary choices have led to much of the chronic illness faced by Americans today. Not everyone is likely to “go totally vegan,” but strictly limiting the amount of animal protein consumed can go a very long way to preventing and even reversing chronic illnesses, including diabetes, heart disease, and even cancers.

    One might even say with some confidence that if everyone made healthy food choices, our rapidly expanding medical expenses would be sharply reduced. The work of Dr. Esselstyn and his son, Rip, and the “Engine 2 Diet,” as one example among many, clearly point this out.

    I enjoy reading your blog; not all apply to me directly, as I am a 73-year old semi-retired Medicare recipient, but many do! Thanks for sharing it.

  2. Objectively, health care appears to be a universal need. However, why should I have higher premiums so some overweight person can chain-smoke and drink a case of beer a day?!?

    All I know is private companies don’t like being told how much profit they can or can’t make. When the Gov’t steps in and tells them they now have to offer yearly physicals at no charge, they will just find a way to make the money elsewhere ($1000 ultrasound, $8000 ear tube…).

    On the other hand, if it was completely taken over by the Gov’t, much incentive would be lost to find better medicines, treatments, cures, techniques, etc.

    We pay a lot in premiums and have a very high deductible. Our medical costs have only been semi-devastating. The Gov’t plan appears to be making it worse.

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