Fixing Healthcare: Working Together

by Amanda Upton

Why is health insurance not an easy fix? Why is fixing the healthcare issues we have in this country not easy? Why can’t everyone just have healthcare at a cheap price?

There is no simple answer to healthcare because in the reality we want two opposites, just like many things in America. We want Walmart prices, but we think Walmart should not get subsidies to keep the prices that low, and then we get mad at Walmart workers when they need welfare programs, but yet we demand lower prices. It’s the same thing in healthcare. We want amazing, but we want the money to come from the sky.

Now I get that there are people in this country who don’t want kids like mine to have healthcare because of multiple reasons, many of which are rooted in hate, but I’m going to segment them to the side and pretend like they don’t exist, partially because thinking about them makes me feel ill and angry.

Why is Healthcare Expensive?

We want healthcare and we want it cheap…but here are the issues when those two things collide:

Doctors and hospitals cost money.

Yes, there are some costs that need trimming. I still struggle with the fact that our insurance is charged over $4,000 when a feeding tube is changed in one of my children, a procedure that is relatively quick. I think it is obviously worth more then $100, but I struggle with $4,000. However, in many cases the charges for a doctor can be justified. We have to pay doctors a good wage for all of the years of medical school and all of the work they do. I honestly had a doctor writing me back late at night recently just to make sure my kid was OK. Many work nights, weekends, and holidays. It is not an easy job.

And doctors are not a single player on a medical team. There are so many people that go into making a hospital work. As someone who spends a lot of time in hospitals, I see all of the dedicated people working hard to keep my kids alive. Those people need to be paid, and those people deserve to be paid well for the work they are doing. There needs to be a financial incentive.

Insurers want to make a profit.

Another problem is that insurance companies exist to make money. Making money at the root is not a bad thing, and of course I like it when my husband’s paycheck hits our bank account. But money often causes people to want more of it, and for one person to get more, someone else has to get less. That is how it works. If it didn’t work that way our currency would be useless. But the problem with many companies is they like to make money despite who it hurts. Companies are not people; they are moneymaking (or losing) machines. That is their purpose.

One of the hard things about health insurance being run by companies is that they will always be looking to make a profit. But in the world of insurance, children like mine do not help them to make a profit; therefore, they are going to charge more to everyone to boost their bottom line. Insurance companies are going to keep raising prices because they can. Just look at what the CEOs of health insurance companies make. They are not hurting. I understand it takes a lot to run a health insurance company and those people need to be properly paid for their work, but the amount they are being paid while lifesaving care for people gets denied makes me scratch my head.

Not every medical condition has a simple fix.

Most people think, “I’m sick, I will go to the doctor and be better soon,” but my kids will show you that that is not always the case. Sometimes it takes lots of doctors and lots of specialists. If you have strep throat there is a doctor visit, throat swab, and antibiotics. With strep you will likely be fine soon and go on your way, but not everything is as simple as strep. Many conditions take many doctor visits, and each time those cost money. We talk to someone on our medical team at least once a week. I was joking with a friend last night that it feels like talking to someone in our medical world is always on our to-do list.

So we want everyone to have healthcare but we want it cheap…but, here is the problem: not everyone’s healthcare costs are cheap.

Medically Complex = Expensive

Before the Affordable Care Act (Obamacare or ACA), there were high risk pools for people with major medical issues. On paper, this sounds OK for people who do not have underlying conditions; however, the people that are in the high risk pool have extremely costly premiums, because everyone in the pool has high medical expenses and is pulling from the same pool of money. High risk pools fail the people that need insurance the most.

The idea behind successful insurance is that everyone is in the same pool, and we all share each other’s health costs. In reality, the thought behind insurance is very Christian, loving one another, and helping each other out. We need lots of healthy, low-cost individuals to balance out the few medically complex expensive ones.

People’s lives depend on insurance, but often we think about it in terms of “me.” I understand that because of my children’s healthcare costs, the cost of everyone’s healthcare is going to be higher. I get that and am thankful for everyone who pitches in. But if your child became sick tomorrow wouldn’t you want the same thing?

Commonsense Reforms

I am not a person that wants government regulation in everything, but I know that in some areas for the benefit of society we need it. So here are some things that I think need to be in healthcare regulation and government programs to make it so insurance works best for us as a whole:

We must have coverage of pre-existing conditions.

It is not my children’s fault they were born with a genetic disorder. Not letting them have health insurance because of it is cruel. I have been an uninsured adult because my asthma is considered a pre-existing condition. I was watching a news clip the other night of a baby who was denied health insurance before ACA because his body mass index was high…he was a baby! Even pregnancy is considered a pre-existing condition.

When you start picking and choosing who can be covered, you are saying health insurance is only for healthy people. This does not make sense, as you are excluding the people who need it most. Also, anyone at any time could have a health condition arise that then qualifies as a pre-existing condition. Just because you don’t have a pre-existing condition today does not mean it will always be that way.

There cannot be limits on total dollars spent.

I am talking about lifetime maximums that existed before the ACA. Lifetime maximums were hard and fast numbers, and once you hit the one or two million dollar max, the insurance company paid zero. Before the ACA, it was not uncommon for someone to have cancer or a baby to be born prematurely and hit the lifetime max very quickly, sometimes within months. Then, they lose their insurance coverage and there is no one to pay the bills. Once again, any of us at any time could have a sudden medical problem happen that makes us hit that maximum. Just because you are healthy today does not mean you will be tomorrow.

Health Savings Accounts cannot be used as a main healthcare source.

Many proposals encourage Americans to open Health Savings Accounts (HSAs) in order to pay for later health expenses. But to have money in an HSA, you have to have money to put in it. That is how they work. Last year, just one of our children’s medical bills cost over $100,000. We don’t make that much in a year, and therefore we can’t put that much into an HSA. It just doesn’t work unless you are extremely wealthy. All an HSA does is take your own money and make it tax-free when using it for healthcare. There is no magic that happens there. What you put in is what you can pull out.

Medicaid block grants and per capita caps don’t work.

This has been proven over and over by independent financial analysts. The only thing that block grants are good for is saving money for the federal government. They put a strain on states, and they hurt the people who need Medicaid services the most. What happens when that money runs out halfway through the year? People just don’t get health services for the rest of the year? Healthcare has costs that are not always planned. I was not planning for my child to go into interventional radiology last week but it was needed.

My other concern with block grants is Congress keeping up their share of the bill. Votes have shown that they don’t want to pay to fund healthcare programs, and when it comes to block grants, who says the amount of money will increase with rising costs? Who says the pot of money will actually be funded? Safeguards need to be in place to make sure this money stays around, because Congress is really good at dipping their hands into pots of money for other things.

We need to keep preventative care.

Paying for someone to receive preventative care has been proven over and over and over again to be cheaper. Logically that needs to be left alone.

Tax credits are not the same as the subsidies.

There is a difference and we cannot act like they do the same thing or help people the same way. Tax credits don’t help the poorest Americans.

Healthcare Isn’t Easy

Healthcare is not easy, and we need to find solutions that help people. There is not a golden clear-cut answer for health insurance. I keep hoping that anything that comes from healthcare reform is logical and for the people, rather than for the pockets of the wealthy or corporations. We need healthcare that works for the people. If we are going to leave health insurance in the hands of companies, then we need to protect the people, because in many instances what is best for the people when it comes to health insurance is not what is going to make the most money. We need to join together and set standards.

Most people want cheap health insurance for themselves and want it to cover everything, but the fact is that the math just does not add up. Health insurance is something we need to work together on. We all pay in, we all help out, and we all keep insurance companies accountable. We each try our best to make sure insurance is not being charged for things that are unnecessary, because keeping costs lower help us all. You do not live here on an island all by yourself totally unaffected by everyone else. God made us to be interdependent and to love and take care of one another. We each need to do our part in that.

Healthcare is not an easy fix, but I bet if most of us sat down and talked about it, most of us would agree on most things about it. Right now the ACA does many things right. There are obviously many issues, and I’m not blind to that, but a lot of those issues result from us having a for-profit healthcare system. So I challenge you today, read what the ACA actually covers, because it covers a lot more then you probably think, and then contact people about your views. One of the good things about this past month is that many people are learning what all is in ACA. So many people hated it just for its “name” Obamacare. Be respectfully vocal.

So let’s work together. Let’s love one another. Sometimes that is going to mean you pay more to help others, but in reality, what goes around comes around. Don’t say this doesn’t affect you and bury your head. While it might not affect you today, it will someday. There are going to be times you need help, too.

Author: Amanda Upton • Date: 3/14/2017

About the Author

Amanda is married to Brent and has two children, Jillian and Lydia. They are both still considered undiagnosed although it is thought that there is an underlying muscle issue with a maternal genetic inheritance as Amanda has many similar symptoms, just not as severe as the girls. They both have GJ-tubes and Jillian is on oxygen and has leg braces. They are the happiest kids, and they both love making people at our local children’s hospital smile. Jillian’s favorite things revolve around pink, purple, glitter, and tutus, and she is ok with all the medical stuff as long as she can make it girly. Lydia loves smiling and cuddling. They are a big Disney family and planning trips to the parks is their stress relief.

Amanda has a degree in early childhood education in both regular and special ed and taught 4K until Jillian was two years old, when she became a stay-at-home mom to help protect Jillian’s lungs from germs. They rely on their faith, friends, and family to get them through the hard aspects of being a medically complex family. Her blog can be found at

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