For-Profit Healthcare Not the Fault of Disabled People

Cyrus Eosphoros, Contributing Writer

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Green Party presidential candidate Jill Stein’s staff tweeted against the Affordable Care Act Wednesday: “Obamacare guarantees $400bn in profits for insurance companies by creating a captured market. A profiteering, private system isn’t reform.”

A statement claiming that 17 million people gaining insurance after the ACA makes a bad policy wouldn’t be amiss from one of the Bernie Sanders-supporting social scientists I follow, like Michael Oman-Reagan (“The thing I disliked the most about ACA is that it forces Americans to prop up the for-profit healthcare industry”) or Holly Wood (“Great, [the ACA] made it that much harder to defeat for-profit healthcare”). The first sentence of Stein’s tweet even sounds like a conservative could have written it. The idea that only insurance companies are reaping benefits from the ACA are insurance companies has become an unlikely bipartisan talking point.

Insurance works using a system of calculated risk. It’s profitable because people generally pay more into the general pool than they take out. In theory, this means that it is in insurance companies’ interest for everyone to have health insurance — as long as it originates from them. The belief is that Obamacare’s universal coverage really does serve insurers. However, this assumes that all risks for all people are equal.

In real life, disabled and chronically ill people exist. Insurers, who make money by charging people more money than their healthcare costs, are intensely aware of this. That’s why, until recently, it was legal and common for people to be denied insurance because of a preexisting condition — that is, a chronic illness or disability.

When disabled people did manage to get insurance, they were charged higher premiums for plans that did not cover treatment for the very illnesses they needed to treat. The ACA made both of these practices illegal. Six years later, we seem to have forgotten this. When people on both sides of the aisle blame the law for making some insurance premiums higher, they may not even know they’re really decrying the existence of disabled people.

Politicians from the left and right alike have latched onto this idea to justify something better than Obamacare — whatever their definition of “better” is. For the right, it’s abolishing regulations that force insurance companies to serve all potential customers.

The way the left’s objection is phrased is superficially more palatable. Liberals claim that “healthcare is a human right, so why are people paying for it at all?” — and I agree — but then blame the fact that we still must shell out for insurance because of the Obama administration’s failure to push healthcare reform far enough. This logic is almost more disappointing, because what the loose conglomerate of leftists, liberals and Democrats supposedly have in common is greater respect for the humanity of marginalized groups than their right wing counterparts.

It’s ironic that the left ends up taking the same basic interpretation as conservatives, the people who blocked healthcare reform in the U.S. before. It’s amazing that we have come this close to equity in coverage given extreme rightwing opposition.

Arguing that an increase in people using private insurance plays into insurance companies’ hands requires the belief that the newly-insured were customers companies actually wanted. To say Obamacare guarantees additional profits for private insurers ignores the fact that it forces those same insurers to pay for people who need more healthcare than average.

It also assumes participation in this marketplace is willing. It assumes that people who didn’t have insurance didn’t want to, instead of considering the historical fact that it was legal to deny hundreds of millions of people insurance based on their health.

The argument that more insured people is bad is rooted in deeply ableist, and false, assumptions. It depends on the belief that newly insured Americans have been forced into a system from which they were purposefully abstaining instead of being denied access in the first place.

Do people know that the ACA is the reason denial of service based on preexisting conditions is illegal? Do they even know that happened in the first place?

The part of the ACA that appears to have been lost in the shuffle was, for me, also the most important. Before Obamacare, I never would have had health insurance in the U.S., because any of the congenital conditions that make insurance a lifesaver for me were enough for any company to reject me as a customer. My family tried to get insurance once before the ACA. I was rejected for having scoliosis, one of the disabilities that impacts me least and a disease that affects over six million Americans.

According to the CDC, 50 percent of American adults have some form of chronic disease. Twenty percent of all American adults are disabled. We are one of the largest marginalized minority groups, and the only one that anyone can join at any point in their life.

But Stein is not alone in forgetting to put us in the picture. She’s not even an outlier. The vast majority of the time, people in power only take disabled people into account in order to figure out how to keep us out — out of power, out of public spaces, out of society.

If insurance companies wanted my money, they wouldn’t have had to be legally obligated to accept it. People who act like the ACA created a captured market ignore the fact that this market was already captive. The fact that there were masses of people without insurance is not because they were forced to buy it. It’s because insurance companies have been forced to sell.

For-profit healthcare is a predatory system, because all systems that commodify human survival in a world where it’s not a guarantee are predatory. Blaming the people who are now insured thanks to Obamacare for continuing this predation is nothing more than victim-blaming. To fault the people who received lifesaving insurance — however imperfect — when it was previously denied to us is claiming it’s the fault of people who would die without healthcare that this healthcare needs to be bought.

Not all people need an equal amount of healthcare. That’s why it was more profitable for insurers to serve only the healthy and abled. The “captive market” they’ve been given isn’t one insurers actually wanted. If I’m paying the same premiums as an abled, healthy person and my insurer is taking on my double-digit list of prescriptions and the multiple monthly checkups that keep me alive, they’re losing more money than I’m paying them. Insurers aren’t stupid. When your way of making money is by gambling that the people who are paying for your services won’t need them, taking on clients who definitely will require and even depend on what they’re paying for isn’t in the best interests of the bottom line.

Private insurance is a fundamentally predatory system. The world will be better without it — if and when it is replaced with something better. But integrating everyone into the existing system saves lives. Obamacare isn’t helping private insurers compared to the previous status quo. If insurers had wanted the ACA’s provisions to happen—ifthey’dbeenthesoleorevenprimary beneficiaries — the law wouldn’t have been necessary in the first place.

Without access, people like me don’t get to wait for a better solution to come along. We don’t muddle along without healthcare indefinitely, fearing the worst, the way healthy people do. We don’t get to fight for further change.

We just die.

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