Reed said "a lot of people tend to 'catastrophize' about the Affordable Health Care act ..." This is wrong. I lot of people, in fact the majority dislike Obamacare and do not/did not want it to be implemented. I was forced to buy my personal health insurance costing $6,000 a year only after increasing the deductible to $15,000; result is my out of pocket last year was $8,000 for someone on fixed income retirement annuity of under $30,000. So they say, well you can always get federal assistance for low income persons/ families... should a federal mandate whose overall objective is to effect wealth transfer from one segment of the population to another result in the government taking over an entire industry that represents nearly a fifth of the total economy. This is not "catastrophizing" but speaking the plain truth. Obamacare is a monster out of control... reminding me of the 1955 movie I watched as a kid "It Came From Beneath the Sea"...https://www.youtube.com/watch?v=uJqXEhMdlg4. It was a horrible movie just as Obamacare is a horrible mandate forced on The People, majority of whom did not want/like it and this has remained the case since it began. Is this democracy.
9
Sorry Mr. Abelson & Ms Sanger-Katz but you really don't get the problem.
The concept of insurance is that you spread the risk. In order to do a good job of spreading the risk you need to spread it far and wide. That is not happening here.
The ACA plans are very localized. The risk pools are too minuscule to do any spreading of the risk. Those new co-ops were dead upon arrival. You can't spread risk with only 150,000 subscribers. At the very least the plans should have been statewide or regional. You would need a population of tens of millions of people to make this work. On top of that the pool must include everyone who has insurance, not just the ACA group.
The few big insurers, who certainly didn't want a one-payer system, aren't going to be bankrupt by adding a few million more subscribers. But they want it all and if they can't have everything, they don't want to and don't have to play. The ACA or the states should have mandated that every insurer who offers policies in a state should be required to offer ACA policies too with the same level of networks. That would have be a start to spreading the risk among more insurers and a larger population.
In short, the ACA was designed to fail.
The concept of insurance is that you spread the risk. In order to do a good job of spreading the risk you need to spread it far and wide. That is not happening here.
The ACA plans are very localized. The risk pools are too minuscule to do any spreading of the risk. Those new co-ops were dead upon arrival. You can't spread risk with only 150,000 subscribers. At the very least the plans should have been statewide or regional. You would need a population of tens of millions of people to make this work. On top of that the pool must include everyone who has insurance, not just the ACA group.
The few big insurers, who certainly didn't want a one-payer system, aren't going to be bankrupt by adding a few million more subscribers. But they want it all and if they can't have everything, they don't want to and don't have to play. The ACA or the states should have mandated that every insurer who offers policies in a state should be required to offer ACA policies too with the same level of networks. That would have be a start to spreading the risk among more insurers and a larger population.
In short, the ACA was designed to fail.
13
It works for me.
Because of obamacare i lost my network of doctors and was hemorrhaging money every month while getting nothing back. The deductibles were insane, while paying monthly, while getting the minimum. As a freelancer, i was just not making enough to survive w/ health coverage so i, for the first time in my life, am now uncovered. i have no doubt there are others in the same boat.
10
The reporters' conversation never touches the umbrella issue the ACA tips on.
It is obscene to have for profit insurance companies in the drivers seat of healthcare costs, and allow them to raise rates each year. This is not cost control, it is a giveaway to the CEO's, who take home 10 million/year.
It is obscene to have for profit insurance companies in the drivers seat of healthcare costs, and allow them to raise rates each year. This is not cost control, it is a giveaway to the CEO's, who take home 10 million/year.
24
My 59 year old husband has always been self employed. He was able to get great health insurance through my jobs running social service agencies. I recently retired and so the Affordable Care Act has been critical. Here in Missouri where our statehouse believes all government is bad, we have no exchange and they refused the Medicaid money. So, he buys his insurance through the Federal Exchange without subsidies. He has a $6,000 deductible and pays about $7,000 a year which is about $150 more per month than when he was on my insurance. It's far from perfect but better than the $1,200 a month quotes he was getting before ACA. In truth, if deductibles and premiums rise, it will really put a hurt on our family.
7
I believe that Obamacare is a case of good intent and EXTREMELY bad design. It has never worked as promised and all appearances are that it will only get worse.
11
Although I have no love for the insurance companies, they (and thus we) are getting screwed by the folks who are allowed to enroll in the ACA just about any time. A previous article in the Times pointed out that the Obama administration, in an effort to get more folks enrolled, created almost 30 different 'classes' of exceptions to annual enrollment.
Now, if you fit into one of those exceptions you can refuse to buy any insurance for you or your family, thus saving a ton of money in premiums in exchange for paying a small penalty. However, if you suddenly fall ill, no matter how dire or expensive, you can jump right in and the insurance company is on the hook for your treatment.
And after you're finally cured? Just drop right out again and game the system like before. Who looses here? Everyone else who is covered by the ACA and is not gaming the system the way these folks are- in the form of higher premiums. Thank you Washington for once again playing around with a law and creating all sorts of exceptions that are great for a few and screw everyone else. Haven't you learned your lesson already with the mess you've made of the tax code?
Now, if you fit into one of those exceptions you can refuse to buy any insurance for you or your family, thus saving a ton of money in premiums in exchange for paying a small penalty. However, if you suddenly fall ill, no matter how dire or expensive, you can jump right in and the insurance company is on the hook for your treatment.
And after you're finally cured? Just drop right out again and game the system like before. Who looses here? Everyone else who is covered by the ACA and is not gaming the system the way these folks are- in the form of higher premiums. Thank you Washington for once again playing around with a law and creating all sorts of exceptions that are great for a few and screw everyone else. Haven't you learned your lesson already with the mess you've made of the tax code?
8
Hi Reed...as you know from my interviews in Dec. 2013, I have a policy through the Kentucky health exchange which is being closed. I have found another huge issue with Obamacare and there seem to be no resources to help me. I never got a correct tax form for 2014. Kynect blames Blue Cross Anthem for that. I have had my state representative working on that for a year. For 2015, the IRS rejected by form for the tax subsidy. The folks at H & R Block were clueless. There doesn't seem to be anyone who understands the relationship between the payment assistance given on the reported 1095A and the IRS Form 8962. Kynect wants to give me a $454 a month subsidy but the IRS says I have to repay almost all of that. This is so maddening. CPA's don't have clients who get the subsidies, so they don't understand, most people who benefit from Kyect qualify for Medicaid so they are not affected. But it has all been a huge disappointment and hassle.
5
Haven't we always known that Obamacare would initially attract a lot of people with chronic diseases that couldn't get insurance before? The healthy younger folks are just waiting to get sick or have an accident, and that's when they'll enroll. Once enrolled, they may wake up to the fact that we're all going to get sick or have an accident and die from an untreatable condition --and therefore stick with the insurance. Also, health insurance is such an expensive item that people are likely both to check competitive rates and to increase their coverage as they understand their healthcare needs better.
1
WINTHROP OMUCHCHO-
I agree- United Health Care is No big Loss. They charge too much and customer service is not good.
I predict that good non-profits will take over the Exchanges. Kaiser Permanente is a good model. They are both an insurer and a provider.
Their docs are on salary. Because they are not paid “fee for service” they have no incentive to over-treat. Kaiser owns its own hospitals and they’re quite efficient.
Patients are happy-. In California, some families have stuck with Kaiser for generations. And Docs are pretty happy; once they’re affiliated with KP they, too stay.
Even in NYC I have found a good non-profit: Mt. Sinai Health First.
It will take time for the model to spread, but I think it will.
I agree- United Health Care is No big Loss. They charge too much and customer service is not good.
I predict that good non-profits will take over the Exchanges. Kaiser Permanente is a good model. They are both an insurer and a provider.
Their docs are on salary. Because they are not paid “fee for service” they have no incentive to over-treat. Kaiser owns its own hospitals and they’re quite efficient.
Patients are happy-. In California, some families have stuck with Kaiser for generations. And Docs are pretty happy; once they’re affiliated with KP they, too stay.
Even in NYC I have found a good non-profit: Mt. Sinai Health First.
It will take time for the model to spread, but I think it will.
6
Oh boo hoo.
My daughter, a recent college grad with a history major just turned 26 and aged out of my wife's group Blue Cross policy with her employer.
She's making less than 20k a year as a waitress/nanny and just hooked up with Aetna under the ACA with similar co pays and deductible she had with Blue but for $20 a month with the ACA subsidy. United Healtcare was offered too as a choice but characteristically wanted twice as much with fewer benefits.
My daughter would have qualified for Medicaid under the ACA if our bigoted governor McCrory would have expanded it but as the world knows by now he follows what Tea Party dictates like a lemming marching toward the sea of his defeat in his reelection bid in November.
NC has failed to cover 500,00 of its poor under expanded Medcaid and forgone 4 BILLION dollars in free federal money. Whatever.
And United Healthcare pulling out of markets? Good riddance. I remember before the passage of the ACA UH's chairman being hauled before a Congressional committee to explain why they had denyed coverage to a woman with stage 4 breast cancer 3 days before a scheduled double mastectomy because she failed to disclose on her policy application she had had acne, which obviously had nothing to do with her cancer
This is the emblematic of the heartless and conniving character of the executives who ran UH and other large health insurers before the ACA.
Want to go back to the dark ages of healthcare?
Keep voting for the Greedy Old Pigs.
My daughter, a recent college grad with a history major just turned 26 and aged out of my wife's group Blue Cross policy with her employer.
She's making less than 20k a year as a waitress/nanny and just hooked up with Aetna under the ACA with similar co pays and deductible she had with Blue but for $20 a month with the ACA subsidy. United Healtcare was offered too as a choice but characteristically wanted twice as much with fewer benefits.
My daughter would have qualified for Medicaid under the ACA if our bigoted governor McCrory would have expanded it but as the world knows by now he follows what Tea Party dictates like a lemming marching toward the sea of his defeat in his reelection bid in November.
NC has failed to cover 500,00 of its poor under expanded Medcaid and forgone 4 BILLION dollars in free federal money. Whatever.
And United Healthcare pulling out of markets? Good riddance. I remember before the passage of the ACA UH's chairman being hauled before a Congressional committee to explain why they had denyed coverage to a woman with stage 4 breast cancer 3 days before a scheduled double mastectomy because she failed to disclose on her policy application she had had acne, which obviously had nothing to do with her cancer
This is the emblematic of the heartless and conniving character of the executives who ran UH and other large health insurers before the ACA.
Want to go back to the dark ages of healthcare?
Keep voting for the Greedy Old Pigs.
19
Health insurance can not be a market good. It breaks all of the rules of a "perfect market" so badly that it has to be a failed market:
Information is scarce, not ubiquitous; There are many buyers but only a few sellers,; There are huge barriers to entry into the market; All products are not the same.
The whole point of insurance is to have a big pool of customers to spread the risk around. Many insurance companies actual split up their customers in to separate pools so that they can justify price gouging. "Someone at your company has cancer so we have to double your rate." The more insurance companies there are the smaller their pools are and the riskier the business model.
The biggest possible pool is everyone in the country. That is the least risky and most predictable way to spread the risk. That would mean one insurance company, a monopoly. This should be the government. It works in many countries, delivering better results for less money.
Information is scarce, not ubiquitous; There are many buyers but only a few sellers,; There are huge barriers to entry into the market; All products are not the same.
The whole point of insurance is to have a big pool of customers to spread the risk around. Many insurance companies actual split up their customers in to separate pools so that they can justify price gouging. "Someone at your company has cancer so we have to double your rate." The more insurance companies there are the smaller their pools are and the riskier the business model.
The biggest possible pool is everyone in the country. That is the least risky and most predictable way to spread the risk. That would mean one insurance company, a monopoly. This should be the government. It works in many countries, delivering better results for less money.
14
J McGloin--
If the single-payer model works, why don’t more countries use it?
Canada and the UK are the two that rely on single-payer, and in the UK it’s not well-funded.
Throughout Western Europe hybrid systems that include insurers as well as government have developed the most successful systems. When measured in terms of quality, mortality is lower than in the U.S., and patient satisfaction is higher than in the UK and Canada.
The systems in Western Europe are also much less expensive than ours because their doctors don’t expect mega-bucks, and their hospitals are more efficient. They are less likely over-treat and practice evidence-based medicine.
In the U.S. doctors belong to the highest-paid profession in the country.
Many specialists are in the top 1%.
If we tried to switch to single-payer, we could never afford it unless we
slashed specialists’ salaries by, say, 30% and penalized hospitals for doing too many MRI’s etc.
Vermont discovered that single-payer just isn’t affordable.
If the single-payer model works, why don’t more countries use it?
Canada and the UK are the two that rely on single-payer, and in the UK it’s not well-funded.
Throughout Western Europe hybrid systems that include insurers as well as government have developed the most successful systems. When measured in terms of quality, mortality is lower than in the U.S., and patient satisfaction is higher than in the UK and Canada.
The systems in Western Europe are also much less expensive than ours because their doctors don’t expect mega-bucks, and their hospitals are more efficient. They are less likely over-treat and practice evidence-based medicine.
In the U.S. doctors belong to the highest-paid profession in the country.
Many specialists are in the top 1%.
If we tried to switch to single-payer, we could never afford it unless we
slashed specialists’ salaries by, say, 30% and penalized hospitals for doing too many MRI’s etc.
Vermont discovered that single-payer just isn’t affordable.
6
The system is broken. It could be fixed but would require too many well heeled interests to take a hair cut and would require a conscious admission that we cannot give everything to all. Add to this our dysfunctional leaderless governing body and it is obvious that there must by a total crash with a new building after it happens.
No other country in the world has such a thing as medical bankruptcy. At least 16 countries have better health outcomes than we do. We spend more money insuring fewer people to get those dismal results. Don't smoke, exercise, be happy, live within your means and stay away from corporate medicine.
No other country in the world has such a thing as medical bankruptcy. At least 16 countries have better health outcomes than we do. We spend more money insuring fewer people to get those dismal results. Don't smoke, exercise, be happy, live within your means and stay away from corporate medicine.
9
Has anyone examined the health insurance companys' mismanagement and the unnecessary expenses that exist within their walls?
Everyone is fast to look at failures of the Affordable Care Act as the cause of the problem of high costs and smaller profits by healthcare companies. If the CEOs and managers had salaries that were not excessive, and better systems and procedures in place that were efficient, and had constrained budgets, and smaller expense accounts, higher profits would be realized. The Healthcare Companies have become an economy in and of themselves and they are not managed effectively. They are quick to blame the Affordable Care Act for their reduced profits. When we have public companies that have fiduciary responsibilities to their share holders while needing to provide services to hundreds and thousands of new subscribers at lower rates, there is a disconnect. If they managed their companies better,everyone could win. It's easier to blame Obama than to become efficient, and reduce staff, salaries and perks to reasonable levels.
Everyone is fast to look at failures of the Affordable Care Act as the cause of the problem of high costs and smaller profits by healthcare companies. If the CEOs and managers had salaries that were not excessive, and better systems and procedures in place that were efficient, and had constrained budgets, and smaller expense accounts, higher profits would be realized. The Healthcare Companies have become an economy in and of themselves and they are not managed effectively. They are quick to blame the Affordable Care Act for their reduced profits. When we have public companies that have fiduciary responsibilities to their share holders while needing to provide services to hundreds and thousands of new subscribers at lower rates, there is a disconnect. If they managed their companies better,everyone could win. It's easier to blame Obama than to become efficient, and reduce staff, salaries and perks to reasonable levels.
12
Insurance company employees and managers, with the exception of those in the C-suites, are not exactly raking it in. Wages for many have not increased past the rate of inflation, if that, and some are actually at the level of the working poor. Insurers employ many skilled people as a result of government regulations, like filing requirements, by the way.
I am thankful for insurers, because they are the only barrier between me and the exorbitant costs of healthcare, spurred mostly by inflated healthcare worker compensation and excessive staffing.
I am thankful for insurers, because they are the only barrier between me and the exorbitant costs of healthcare, spurred mostly by inflated healthcare worker compensation and excessive staffing.
1
The curse that is Obama Care will be Obama's enduring legacy. Poorly conceived and terribly executed.
My health insurance cost is now 40% higher that pre Obama but I've lost coverage I need such as Chiropractic and been forced to buy useless riders for things like pediatric dental and pregnancy care (I'm a 60 year old man).
Most of America is like me and will vote for the first politician that can get rid of it and give us back what he stole from us, or perhaps a wonderful system like we had here in Minnesota, MCHA which guaranteed coverage to all at a premium no higher than 25% of regular coverage. Everyone has to have some skin in the game or else it becomes a scam magnet for illegals and gold brickers like we have today.
My health insurance cost is now 40% higher that pre Obama but I've lost coverage I need such as Chiropractic and been forced to buy useless riders for things like pediatric dental and pregnancy care (I'm a 60 year old man).
Most of America is like me and will vote for the first politician that can get rid of it and give us back what he stole from us, or perhaps a wonderful system like we had here in Minnesota, MCHA which guaranteed coverage to all at a premium no higher than 25% of regular coverage. Everyone has to have some skin in the game or else it becomes a scam magnet for illegals and gold brickers like we have today.
8
Obamacare is here to stay.
The train has left the station; it is too late to take it away from the many people who are benefiting.
We can improve it, however, and in the years ahead, we will see changes.
More doctors will be working on salary (rather than charing fee-for-service, which we know invites over-treatment.) More providers will be practicing evidence-based medicine--if they don’t they’ll face financial penalties.
Med schools will be putting more emphasis on “palliative care” rather than
“do everything possible” until the bitter (and often very painful) end.
Health care reform is not an event. It is a process. Over time, the process will
continue, and care will become both more affordable, and better. When it
comes to healthcare, lower costs and higher quality go hand in hand.
The train has left the station; it is too late to take it away from the many people who are benefiting.
We can improve it, however, and in the years ahead, we will see changes.
More doctors will be working on salary (rather than charing fee-for-service, which we know invites over-treatment.) More providers will be practicing evidence-based medicine--if they don’t they’ll face financial penalties.
Med schools will be putting more emphasis on “palliative care” rather than
“do everything possible” until the bitter (and often very painful) end.
Health care reform is not an event. It is a process. Over time, the process will
continue, and care will become both more affordable, and better. When it
comes to healthcare, lower costs and higher quality go hand in hand.
5
ACA shifted unaffordability from the poor to the middle class. The poor haven't benefited much, though. Unless you're dying, Medicaid appointments are all but unobtainable, rife with long waits, multiple provider-canceled appointments, etc. The middle suffers, though, with staggering premiums and deductibles. Rich get richer.
8
We have a system that requires us to buy insurance from private, for profit companies that have limited competition. The system was put in place without tackling the cost of prescription medication and without tort reform. The fines for non-compliance are so low that many young people have opted to stay out of the system. In what universe does such a system make any sense? If I were a conspiracy theorist I would probably believe that Obama, Reed and Pelosi put in place a system so flawed that the ONLY solution would be single payer, national health. If nothing gets done, the only future that we face is higher premiums, higher deductibles, high co-pays and more coverage exclusions.
10
Margot: Well, it seems clear that you need some competition in every market to keep prices low.
This statement, spoken as an axiom, is totally wrong. The cost of health insurance within a system is a function of the health of the people who are being covered. If you have a monopoly, as you do in many markets, it would also seem obvious that you couldn't lose money. To conclude that adding insurers to lower prices in a monopolistic market where the one actor is losing money simply makes no sense. If you're trying to run an exchange in West Virginia, where the population is vastly more unhealthy on the whole than in most states, and the population is poor, you simply can not make it work.
Single payer, please.
Or perhaps expand Medicaid/Medicare in counties where no insurer is willing to provide coverage.
Or perhaps provide Medicaid/Medicare for individuals with multiple chronic conditions universally to reduce the burden of premiums on the remainder of the insured pool.
This statement, spoken as an axiom, is totally wrong. The cost of health insurance within a system is a function of the health of the people who are being covered. If you have a monopoly, as you do in many markets, it would also seem obvious that you couldn't lose money. To conclude that adding insurers to lower prices in a monopolistic market where the one actor is losing money simply makes no sense. If you're trying to run an exchange in West Virginia, where the population is vastly more unhealthy on the whole than in most states, and the population is poor, you simply can not make it work.
Single payer, please.
Or perhaps expand Medicaid/Medicare in counties where no insurer is willing to provide coverage.
Or perhaps provide Medicaid/Medicare for individuals with multiple chronic conditions universally to reduce the burden of premiums on the remainder of the insured pool.
6
Just as some doctors stopped treating Medicare patients because they wanted to get more than the government was willing to pay, so too are insurers resisting any restriction on how much they can charge as well, s o they are opting out of the Obamacare market. Yes there are other factors that go into it, but it just highlights that the costs of providing health care are too high for most individuals, and providers and insurance companies do not want to make any less money providing the services, benefits, savings, and efficiencies be damned.
so where does that leave us? Any health care system that relies on insurance companies to provide health care for a profit is never going to be happy to be accountable to recipients or the government. This has always been the fly in the containment. While Obamacare is better than nothing, it is subject to many problems, including high premiums, lack of choice and limited services.
We can do better and must continue to improve on what is the beginning of true health care reform. Big pharma and big insurance can not be allowed to dictate the terms.
so where does that leave us? Any health care system that relies on insurance companies to provide health care for a profit is never going to be happy to be accountable to recipients or the government. This has always been the fly in the containment. While Obamacare is better than nothing, it is subject to many problems, including high premiums, lack of choice and limited services.
We can do better and must continue to improve on what is the beginning of true health care reform. Big pharma and big insurance can not be allowed to dictate the terms.
12
Nancy--
I agree that we are going to begin refusing to over-pay for drugs sometime in the near future. The pharmaceutical industry (and Walll Street) know this is coming.
Medicare, the nation’s biggest insurers, will lead the way by negotiating for
discounts. If drug companies don’t agree to discounts, their drugs won’t be covered under Medicare. This works in Europe, and it will work here.
Other insurers will follow Medicare’s lead.
As for the big insurance companies--United HealthCare may well be just the first for-profit company to drop out. They don’t like the regulations--in particular the fact that they must insure people suffering from pre-conditions and can’t charge them more.
(This is, of course, one of the best things about Obamacare. No one should be penalized because they have had cancer.)
My guess is that, over time, large for-profit insurers will be replaced by regulated non-profits. This is the model that has been working in Western Europe for a long time.
I agree that we are going to begin refusing to over-pay for drugs sometime in the near future. The pharmaceutical industry (and Walll Street) know this is coming.
Medicare, the nation’s biggest insurers, will lead the way by negotiating for
discounts. If drug companies don’t agree to discounts, their drugs won’t be covered under Medicare. This works in Europe, and it will work here.
Other insurers will follow Medicare’s lead.
As for the big insurance companies--United HealthCare may well be just the first for-profit company to drop out. They don’t like the regulations--in particular the fact that they must insure people suffering from pre-conditions and can’t charge them more.
(This is, of course, one of the best things about Obamacare. No one should be penalized because they have had cancer.)
My guess is that, over time, large for-profit insurers will be replaced by regulated non-profits. This is the model that has been working in Western Europe for a long time.
3
As long as this country views sick people as a source of profit and hospitals are profit centers you are never going to fix the problem.
30
Those of us with our own plans prior to ACA, only had them because we were healthy enough. Otherwise, the insurance companies would have cut us off long ago.
As one of those (I have had a private plan for over 10 years), the pain of seeing our premiums triple and deductibles increase, leaves us very angry. We will have to pay over $27,000 before our insurance company pays a cent.
And just yesterday, I got a letter saying they will no longer cover any of an out-of-network lab fee. Just when did I even know which lab my doctors used? Now I have to make sure they only use the ones listed on the back of the sheet of paper that came in the mail.
The insurance company is also denying prescriptions saying we didn't get prior authorization. Sadly, even is we do, the price is double what I pay using my GoodRX pharmacy discount card. Of course, when I use the card, the amount paid cannot go towards my deductible because it was not approved.
Too Complicated!!!!
As one of those (I have had a private plan for over 10 years), the pain of seeing our premiums triple and deductibles increase, leaves us very angry. We will have to pay over $27,000 before our insurance company pays a cent.
And just yesterday, I got a letter saying they will no longer cover any of an out-of-network lab fee. Just when did I even know which lab my doctors used? Now I have to make sure they only use the ones listed on the back of the sheet of paper that came in the mail.
The insurance company is also denying prescriptions saying we didn't get prior authorization. Sadly, even is we do, the price is double what I pay using my GoodRX pharmacy discount card. Of course, when I use the card, the amount paid cannot go towards my deductible because it was not approved.
Too Complicated!!!!
17
The health care system as it stands in the US will not work (in the sense that it provides affordable care to most people in a timely way) until health care is viewed as a public utility and not as just another marketable commodity. The market model simply doesn't apply to health care, since the principle of supply and demand is poisoned by the fact that the demand side is captive; in other words, a person cannot choose not to have a necessary treatment or procedure in the way that a person can choose not to buy a new car. The entire scenario of health care "profits", "marketplace" and a hospital advertising on city busses that its cardiac unit "has more heart" is simply bizarre. This of course flies in the face of American culture, which is based on the free market. How this will play out over the years is anybody's guess. I don't see any improvement forthcoming even in the not-so-immediate future...
15
If you would like to know what a single-payer, government run healthcare system would look like; visit your local VA.
8
Single payer systems are like anything else: the good, the bad, the ugly. Holding up the VA as an example is sort of ridiculous. Numerous single payer systems are highly successful at 1/2 the price, often far less, of our profit dominated system. English speaking countries (Canada, NZ) tend to struggle with this approach, but the UK has developed a much more successful system then ours. We have a cultural default to the most expensive, and the most complicated. Our 'health care' system totally embraces these defaults with fee for service billing and no hope of ever getting a price estimate, not to mention the most wasteful and Byzantine insurance plans on earth. Where else in our lives do we not expect an estimate?
10
Since everyone seems to hate the private insurance companies, let's have the US government take over the healthcares, I'm sure they can run the system much more efficiently.
8
I'll repeat a previous anecdote that one reader said was just a lie. It isn't. A Canadian friend collapsed on the golf course in Florida, went to the ER locally, then was told that, to be covered, he'd have to return to Canada. This was in JANUARY. He has an appointment for an echocardiogram to determine what, if any, heart damage he sustained. The test is free. It's scheduled for later this month. But what's four months?
2
Um Yeah, Canada actually doesn't at all try to hide the fact that their single payer covers treatment...wait for it...in Canada. And frankly, this isn't particularly unreasonable, especially given US out of control health care costs. A lot of Canadians traveling to the US purchase travel insurance to cover out of country medical care. As for the four months: The Canadian system works via triage (much like ERs in the US...) if your friend had a truely dangerous problem he'd be seen right away.
11
I'm one of the full-pay Obamacare insureds that the insurers are having difficulty retaining from year to year.
I have complaints about the size and composition of provider panels, and the fact that much of the exchange-based panel info turns out to be wrong when you try to confirm it.
I'm also amazed that the insurers are still not required to disclose up front to potential exchange applicants the size of the discounts they have negotiated with providers. That's a huge factor in making cost vs premium projections, and the available data is sketchy even when grudgingly provided.
But apart from those issues, I'm very grateful that I know that I can identify, compare and choose a coverage plan without fear that the insurer will deny my application simply because of a minor health issue a decade ago, which was the norm in the individual market before.
I recognize that as a generally healthy person I'm paying a higher premium than I would in an experience rated system. But if more families that need and use their coverage to a greater extent than I do are able to start businesses and work independently of the terrible employer-based system we have allowed to persist, I'll willingly pay that cost.
I have complaints about the size and composition of provider panels, and the fact that much of the exchange-based panel info turns out to be wrong when you try to confirm it.
I'm also amazed that the insurers are still not required to disclose up front to potential exchange applicants the size of the discounts they have negotiated with providers. That's a huge factor in making cost vs premium projections, and the available data is sketchy even when grudgingly provided.
But apart from those issues, I'm very grateful that I know that I can identify, compare and choose a coverage plan without fear that the insurer will deny my application simply because of a minor health issue a decade ago, which was the norm in the individual market before.
I recognize that as a generally healthy person I'm paying a higher premium than I would in an experience rated system. But if more families that need and use their coverage to a greater extent than I do are able to start businesses and work independently of the terrible employer-based system we have allowed to persist, I'll willingly pay that cost.
8
Hard to imagine how long we will drag along the private health insurance system before it dies a long, ugly death. I have no confidence that it will be soon.
I'm in the small slice of NY Exchange consumers who don't qualify for subsidies. Empire BCBS upped the premiums on my 1 parent/1 child plan by 17.4% in January. At which point, I reached a bizarre milestone: my Silver premium is now $23 less than my rent. (In fairness, I pay less in rent than the average New Yorker but it's hardly nothing.) I expect next January that it will easily race past my rent.
What I hope every day is that I don't have to use my insurance beyond well visits. What a plan.
I'm in the small slice of NY Exchange consumers who don't qualify for subsidies. Empire BCBS upped the premiums on my 1 parent/1 child plan by 17.4% in January. At which point, I reached a bizarre milestone: my Silver premium is now $23 less than my rent. (In fairness, I pay less in rent than the average New Yorker but it's hardly nothing.) I expect next January that it will easily race past my rent.
What I hope every day is that I don't have to use my insurance beyond well visits. What a plan.
16
How about phony? This is about money, not caring about people and their health (regardless of protestations to the contrary by the puppeteers, the puppets, and all the self-serving sycophants).
7
ACA has helped many folks who didn't have Heath Care. That's a good thing!
However for many of us the Premiums are rapidly rising with decreased benefits.
Anyone who has done the Annual search for a fair deal in the Open Market know what a daunting task it is. The results are pay more for less coverage.
However for many of us the Premiums are rapidly rising with decreased benefits.
Anyone who has done the Annual search for a fair deal in the Open Market know what a daunting task it is. The results are pay more for less coverage.
9
Private health insurance is simply unsustainable (in addition be being a horrible product with huge overhead) that will die a death once the inevitable occurs--people simply won't make enough money to pay for it and insurers will seek profits elsewhere.
Until then--we are held captive by this predatory system. Just another example of how greed and profit work in a Country that caters only to wealth extraction making the rich, richer.
Until then--we are held captive by this predatory system. Just another example of how greed and profit work in a Country that caters only to wealth extraction making the rich, richer.
13
Wow. All about money, never about whether American people are able to get the healthcare they need, when they need it.
11
Let no one forget that the ACA is, at its heart, a Republican plan. Sure, not today's rabid Republicans, but still, it is a salve intended to keep a backward, 19th century, largely employer paid paternalistic system functioning. The goals of the system are to keep insurance companies, big pharma and service providers wealthy.
No other advanced country in the world operates its healthcare system this way. Wake up America.
No other advanced country in the world operates its healthcare system this way. Wake up America.
38
The ACA is a Democratic plan passed without a single Republican vote.
4
Eugene - Joseph's point was that "RomneyCare" was the model for "ObamaCare"...
5
We can dream. Single payer, or Medicare for all.
But don't blame the victims. Republicans have used every trick in the book to drain this program of funds and waylay any provisions that removed profits from its rich friends, or helped the poor.
And they did their level best to prevent its passage. Sure, it's deeply flawed, but it still is helping a lot of people who had nothing before.
Bear in mind, Medicare covers people as they get older.
But don't blame the victims. Republicans have used every trick in the book to drain this program of funds and waylay any provisions that removed profits from its rich friends, or helped the poor.
And they did their level best to prevent its passage. Sure, it's deeply flawed, but it still is helping a lot of people who had nothing before.
Bear in mind, Medicare covers people as they get older.
19
Lot of mis-comparisons here. Back in the day, employer subsidized health care was very cheap, and there was screaming if the amount was raised 10 or 20 dollars a month. Once I started paying for my own, it went up ... and up ... and up, to 1000% and more. People who have good insurance have no idea how vulnerable the uninsured are. It's weregild, and before the exclusion was removed, if you were sick you were doomed.
Sounds like it's pretty complicated out there, but a lot of that is down to Republican obstruction, which is varied, nasty, and highly creative.
Sounds like it's pretty complicated out there, but a lot of that is down to Republican obstruction, which is varied, nasty, and highly creative.
21
Many of the concerns raised in this article are misguided. The goal of Obamacare was not to protect private insurance companies' profit margins. The goal was to provide health care insurance coverage to more Americans. By that measure, we are in a better place than we were prior to the law.
9
Michael,
You are so misguided. Obama sidled up to the biggest drivers of healthcare costs from the beginning: private insurers and big pharma. Both have profited from the ACA. It's all about profits for the insurers and always has been. The reason they're complaining and reporting big losses is the Risk Corridor was gutted from the law (by Republicans). Why isn't anyone talking about that? the Risk Corridor is nothing more than federal subsidies for the insurers. Now that they're not getting their billions of our tax dollars, they're posturing that they'll leave the marketplace. Face it, Obama sold out to the insurers to ensure passage of something. That something is a disaster.
You are so misguided. Obama sidled up to the biggest drivers of healthcare costs from the beginning: private insurers and big pharma. Both have profited from the ACA. It's all about profits for the insurers and always has been. The reason they're complaining and reporting big losses is the Risk Corridor was gutted from the law (by Republicans). Why isn't anyone talking about that? the Risk Corridor is nothing more than federal subsidies for the insurers. Now that they're not getting their billions of our tax dollars, they're posturing that they'll leave the marketplace. Face it, Obama sold out to the insurers to ensure passage of something. That something is a disaster.
8
Maybe you should face the fact that Obama had to negiotiate with Big Pharma and bring them on board early or else there would have been no ACA. They would have killed it. During Bush's term and esp in 06 many defeated or retired Republican Congressmen "graduated" into positions at Big Pharma. Bush's Sec. of Defense was, guess what, a CEO ar Searl. They knew healthcare reform was coming eventually and were ready. So face it, the perfect, PO or single payer, gave way to the good which was only plan politically available, ACA.
3
All this talk about whether or not Obamacare is doomed, and not a word about the millions of people who have coverage now who didn't have it before 2014.
Seems like the commentators can't see the forest for the weeds.
Seems like the commentators can't see the forest for the weeds.
15
Having 'coverage' has little to do with being able to access medical care when needed. Sounds good, though.
12
ACA Obamacare:
A perfect example of how holding a health insurance card in America doesn't ensure access to safe quality affordable healthcare or medications.
What a scam. Just another subsidy for the health insurance and pharmaceutical industry profiting off rationing care for patients and and lousy reimbursement for their doctors.
A perfect example of how holding a health insurance card in America doesn't ensure access to safe quality affordable healthcare or medications.
What a scam. Just another subsidy for the health insurance and pharmaceutical industry profiting off rationing care for patients and and lousy reimbursement for their doctors.
20
Very misinformed.
1
Healthcare is a commodity (selling drugs, biotechs), yes, but it is also an investment that pays forward. You give the system just enough juice to keep people happy and healthy. Hopefully the returns on the investment, aka productivity over lifetime of a society, yield more payback than what was invested initially. America healthcare is in a conundrum. It is a voracious capitalistic machine, soon to be fully automated with EHR, that sucks 80% of the healthcare spending during the last two years of life. We are spending 80% of our investment in the last 2 years of our life, perhaps among our least productive years. Considering the average lifespan is 75, this is minuscule. An investment for a productive society needs to be longer, like 40 years (age 20-60). It also requires much more than just money, such as education and infrastructure. The opposite is happening. Our youth is in debt, education is unaffordable at its sticker price, there is no trickling down of the economy. The economy is robust on paper, yes, but economic inequality makes it worse in actuality when you separate the outliers. Wall Street is more interested in short-term gain. They are humans, and greed is part of humanity, and there is a reason why these smart people don't go into medicine. Policy makers don't have the guts, nor the will of the electorate, to "spread the risk." But numbers don't lie, eventually the pain on mainstream will be felt regardless of how it is subsidized - likely in this decade.
7
Single payer. Period. End of discussion.
22
Too expensive, with fee for service and crazy hospital administrative expence, exclamation point!
Vote Sanders and concede the presidency to Cruz or Ryan and have 8 years of winner take all with Republican complete control of government.
Vote Sanders and concede the presidency to Cruz or Ryan and have 8 years of winner take all with Republican complete control of government.
2
Just had screening colonoscopy recommended by my PMD. Now I owe 4500 out of pocket for the procedure. This is because my employer only offers high deductible plans (and I still pay alot for that). I will NEVER see another doctor again unless I am actually dying. This is NOT insurance. It is robbery! Thanks Barry - NOT!!!!!
38
Ross, actually the move to high deductibles was a trend in health insurance that was not caused by the ACA. It was another effort to make healthcare markets work better to bring prices down. The idea was that if insurance paid everything, you'd have a Cadillac colonscopy and if you have "skin in the game" you'd care about the price. It's a theory that totally ignores the massive market asymmetries was one party to the transaction is sick or in pain and doesn't know what he needs and the other party does.
So, the real blame goes to the GOP, whom believe markets always bring the best price, quality, and quantity and don't know a free market from a market ripe for exploitation. If Obama had had a prayer of getting it passed, we'd have single payer.
So, the real blame goes to the GOP, whom believe markets always bring the best price, quality, and quantity and don't know a free market from a market ripe for exploitation. If Obama had had a prayer of getting it passed, we'd have single payer.
17
Wrong target. Don't blame Obama -- you know he tried for better. Sorry about the $4500, but if you have cancer, that's when you'll be glad he fought to get you insurance, because real illness is really expensive. Your $4500 will look like nothing at all. And your insurance company won't be allowed to drop you, because of Obamacare.
Don't blame Obama, blame his opposition. Keep fighting to improve the system.
Don't blame Obama, blame his opposition. Keep fighting to improve the system.
13
Just a thought - the ACA plans allow for a colonoscopy to be a benefit if you are between 50 and 75 and it is just a basic screening. Your doctor may have coded it as "diagnostic". In that case, you owe the $4500. Otherwise, if your PMD just suggested it because everyone should have one (preventative), then have them see how they coded it. Good luck.
2
Pre ACA, NYS offered a state insurance plan for the self-employed that was bare-bones--no ambulance, mental health, therapies, etc., but it sufficed. To qualify, there was a salary ceiling cap which I met. Like so many, my income was a quarter of what I used to make before I was laid off. The premium cost when I joined Healthy NY in 2009 was $168 per month with reasonable co-pays and a low deductible. The year before the ACA became effective, my Healthy NY premium climbed to $450 per month. This climb was in just three years! Under the ACA my co-pays are $264. I am grateful for the ACA. I am sorry that the middle class is so squeezed. Still, I'd rather have my old salary and be middle class again, and pay the higher premium.
7
Prior to the ACA, no one under 65 had health care that truly covered them. It is easy to complain that the prices are still too high, true and we should demand zero out of pocket costs. But it used to be legal to deny care.
* yearly cap is gone
* lifetime cap is gone
* no more denial of care if medically necessary
* limit to out of pocket costs
* no more being denied care if you get sick
* no more being denied care if you had a error in your paperwork
* no more being denied care for "pre-existing conditions"
* no more higher costs for being sick
* no more higher costs for being female
* many fewer deaths due to post-op infections due to ACA changes
* much more access to health records by patients
* much more electronic records which is probably saving lives and giving better quality care
* now, like Canada and other other universal coverage nations, complaining about the health care is no longer a private hell, but a political/policy discussion, that may lead to improvements
* opportunity if we elect Democrats, to get higher wages that will make health more affordable
* opportunity, if we elect Democrats, to push for zero out of pocket plans in every part of America
* massive subsidies for people to pay for health care and small businesses
* free medical care for most people earning up to 133% of poverty (and everybody if states kick out Republican state legislators)
So please continue to complain about the out of pocket costs so that can be addressed by the government.
* yearly cap is gone
* lifetime cap is gone
* no more denial of care if medically necessary
* limit to out of pocket costs
* no more being denied care if you get sick
* no more being denied care if you had a error in your paperwork
* no more being denied care for "pre-existing conditions"
* no more higher costs for being sick
* no more higher costs for being female
* many fewer deaths due to post-op infections due to ACA changes
* much more access to health records by patients
* much more electronic records which is probably saving lives and giving better quality care
* now, like Canada and other other universal coverage nations, complaining about the health care is no longer a private hell, but a political/policy discussion, that may lead to improvements
* opportunity if we elect Democrats, to get higher wages that will make health more affordable
* opportunity, if we elect Democrats, to push for zero out of pocket plans in every part of America
* massive subsidies for people to pay for health care and small businesses
* free medical care for most people earning up to 133% of poverty (and everybody if states kick out Republican state legislators)
So please continue to complain about the out of pocket costs so that can be addressed by the government.
18
The government is not going to fix this. Face it.
4
*Triple cost for being 60.
"The government is not going to fix this. Face it."
Well, not as long as the Republicans have the power to keep it from happening anyway.
Well, not as long as the Republicans have the power to keep it from happening anyway.
4
The irony is that the federal government is already paying 65% of America's healthcare bill and it's enough to have given single payer to us all.
15
So glad I live in Canada...
Y'all really need to move to single-payer. Don't fall victim to the fear-mongering profit-driven health insurers.
I may pay more in taxes, but it's worth every penny to not have to deal with greedy insurers who will put profit over my life.
Y'all really need to move to single-payer. Don't fall victim to the fear-mongering profit-driven health insurers.
I may pay more in taxes, but it's worth every penny to not have to deal with greedy insurers who will put profit over my life.
69
No thanks.
1
Unfortunately, the greedy insurance companies own the legislators our ignorant citizens vote into office. Our citizens demand nothing from their government, but the elite & the corporations demand & receive plenty.
4
Well stated Chris...when will America learn? I also wonder if you are really paying more in taxes with all the hidden taxes we have here and
besides a criminal health care system here we have no universal free or low cost higher ed that so many of our peer countries have.
The right wing here will hunker down in their bunkers and condemn anything other than their de facto criminal system until nobody can afford it except the rich.
besides a criminal health care system here we have no universal free or low cost higher ed that so many of our peer countries have.
The right wing here will hunker down in their bunkers and condemn anything other than their de facto criminal system until nobody can afford it except the rich.
4
If an amendment could be agreed upon ...
The issue with long-term payoffs could be made less severe by transfer payments from each insurance company to the insurers of the same person in prior years.
Lower cost this year? Higher revenue share for prior-year insurers.
Part-year sign-ups could be handled by setting a monthly premium schedule that declines from month one of the policy through month twelve.
The issue with long-term payoffs could be made less severe by transfer payments from each insurance company to the insurers of the same person in prior years.
Lower cost this year? Higher revenue share for prior-year insurers.
Part-year sign-ups could be handled by setting a monthly premium schedule that declines from month one of the policy through month twelve.
What is it that most who comment do not understand about the "for-profit" linked to employment aspect of access to medical care that the US has chosen? So many of the complaints are about the "features" of the for-profit system where access to "for-profit" providers is through "for-profit" insurance companies and employers.
Although I sympathize with those who complain the total cost of their insurance to access medical care and protect against catastrophic health events, has gone up, the reasons for the increases have less to do with Obamacare than the greed of the industry and rising costs. Premiums, deductibles, out of pocket costs, limited networks were all part of the "for-profit" industry before the ACA (and also included lifetime maximums for care and denials for existing conditions) and would have been so much worse without subsidies the ACA made possible for the poorest. The design of a "for-profit" access system does not allow all people to have access at premiums they can afford. "For-profit" means many people will be priced out of access to care as well as the care itself.
Next time, I hope all those who complain will vote for a cost-effective, moral way to deliver health care without profit to all residents in the US similar to what most developed, wealthy democracies have chosen.
Although I sympathize with those who complain the total cost of their insurance to access medical care and protect against catastrophic health events, has gone up, the reasons for the increases have less to do with Obamacare than the greed of the industry and rising costs. Premiums, deductibles, out of pocket costs, limited networks were all part of the "for-profit" industry before the ACA (and also included lifetime maximums for care and denials for existing conditions) and would have been so much worse without subsidies the ACA made possible for the poorest. The design of a "for-profit" access system does not allow all people to have access at premiums they can afford. "For-profit" means many people will be priced out of access to care as well as the care itself.
Next time, I hope all those who complain will vote for a cost-effective, moral way to deliver health care without profit to all residents in the US similar to what most developed, wealthy democracies have chosen.
9
As shown by most of the world's developed countries, single payer is the best and cheapest way to get the best quality care. Having nearly 1000 private insurance companies in the US means not one can negotiate prices low enough. Profit and administration fees (none of which actually goes to improving health) are a huge part of our bill.
But the US doesn't do anything until there is an absolute crisis and that crisis will come soon. Then we'll go to single payer. In the mean time we'll waste trillions of dollars,
But the US doesn't do anything until there is an absolute crisis and that crisis will come soon. Then we'll go to single payer. In the mean time we'll waste trillions of dollars,
35
Thanks to Obamacare, I spent more than 50% of my gross income on medical care in 2015. Before Obamacare, I had a California HIPAA plan in which I was only spending 25% of my income on medical care.
10
My 33 yr. old daughter is healthy (THANK G-D!) and is currently paying $7,200/year for her health care; and is still having to pay ridiculous deductibles on top of that for her absurdly overpriced care; and is still having to wait months for an appointment with a specialist; and is still having to change doctors whenever her present doctor retires, which recently has been twice; and is still having to deal with long waiting times and bad magazines in the waiting room; and is still having to deal with overburdened staff in her doctor’s waiting room who are wrestling with the massive paperwork requirements the government imposes; and has yet to receive a single birthday card from any recipient of Obamacare whose care she is paying for with her taxes.
If she drops her health care and pays a $2000. fine instead, alongside of out-of-pocket medical expenses of $1,000. for routine care, she will have $4,200. to cover medical emergencies and invest for her own future, possibly amounting to $42,000. or more in ten years.
A no brainer I would say. It took me awhile, but I am beginning to understand why they call it Obamacare. It’s because President Obama wants you pay for the medical care of other people while you stand by watching the quality of your own health care deteriorate.
If she drops her health care and pays a $2000. fine instead, alongside of out-of-pocket medical expenses of $1,000. for routine care, she will have $4,200. to cover medical emergencies and invest for her own future, possibly amounting to $42,000. or more in ten years.
A no brainer I would say. It took me awhile, but I am beginning to understand why they call it Obamacare. It’s because President Obama wants you pay for the medical care of other people while you stand by watching the quality of your own health care deteriorate.
20
You've got that right.
7
"That’s not great for middle-class people who pay their own premiums, but most people in the exchanges won’t notice a difference because of the way the subsidies work." You know, I am happy for those who have never had coverage but NOT on the backs of middle class people. WE get no subsidies BECAUSE we are paying for other people. Because of a change in employment status and six months to go before Medicare kicks in, I sought info on the exchange: the cheapest plan is $600+ a month with a $3,000 deductible. This is bad enough but the changes in the way that medical care is being delivered is making it worse. Finding a PCP and getting in to see them is a problem. The bigger problem is paying to see one and being seen by physicians assistant and being billed as if you saw the doctor. Plus, the PCP seems to have been turned into a traffic cop....they just send you to a specialist for anything more complicated than a cold. And then you are off to medical test hell with free-standing, medical group specialty clinics that seem to exist for the sole purpose of draining more and more money from you. If a PCP hasn't already been glommed up into a hospital group, they seem to have financially rewarding connections to these specialty groups that seem to have sprung up overnight. THIS is one of the reasons that healthcare costs are going up. An unintended consequence of ACA or doctors seeing an opportunity to milk the system?
2
Where to start? United Health Care spends money like a drunken sailor on things that have no appreciable impact on the health of their membership. Executive salaries are out of line with their value to the enterprise. Glossy UHC magazines featuring famous personalities arrive periodically in the mail. Phone calls to members, imploring them to arrange for an unknown health care provider to come to their homes (when they already, by requirement, have a PCP) are endless. The pre-auth system is labor-intensive and not especially effective. Waste, waste waste!
Beyond the UHC problems, the larger health insurance system itself is hardly a "system" at all. Insurance companies have historically moved heaven and earth to avoid "adverse selection" and they have not adjusted to well to opening the doors wide. People who are newly insured tend to be sicker than the norm and use more services. It takes about 5 years for this to level off, but 5 years is longer than most members stay in a plan. Plans are loath to pay for somebody to get healthy, only to have them move on (as a lower service user) to another plan. Universal coverage would solve this, but leaders do not have the spine to treat health care as a personal right rather than a population-based commodity.
The population is aging. Many older people have long personal histories of being under-served if at all. Health care delivery is not cheap, but it need not be as expensive as our political system makes it.
Beyond the UHC problems, the larger health insurance system itself is hardly a "system" at all. Insurance companies have historically moved heaven and earth to avoid "adverse selection" and they have not adjusted to well to opening the doors wide. People who are newly insured tend to be sicker than the norm and use more services. It takes about 5 years for this to level off, but 5 years is longer than most members stay in a plan. Plans are loath to pay for somebody to get healthy, only to have them move on (as a lower service user) to another plan. Universal coverage would solve this, but leaders do not have the spine to treat health care as a personal right rather than a population-based commodity.
The population is aging. Many older people have long personal histories of being under-served if at all. Health care delivery is not cheap, but it need not be as expensive as our political system makes it.
16
ObamaCare is, first and foremost, a huge lie, a broken promise. The president won a prize for the biggest lie of the year a short time ago. Like Pinnochio, his nose is getting longer. When do we begin to understand that there is NO SUCH THING as affordable health care? Likewise, there is no such thing as truly affordable comprehensive insurance coverage for a majority of those who need it, or put another way, those who are being forced to buy it. Why? Because the greedy providers and even greedier insurors are making sure that they extract as much as they can as quickly as they are able to. So, folks things are bad and are going to get worse. We need single-payor health insurance. NOW !!!
16
Single payor only puts government more in charge of something they have already botched. No thanks.
3
After reading this article, I went back and reviewed posts on a website run by Healthcare Professional, Allan Katz. In his excellent website, Mr. Katz explained, or attempted to explain the consequences associated with passage of the PPACA. One such post involved premium costs and out of pocket expenditures.
The following is a comment I posted to Mr. Katz blog in August 2009, and references the fact that if you are ineligible for premium subsidies, your out-of-pocket expenses could total 24% of your income.
I am a simple layperson, yet apparently, at least, according to your article, I was able to correctly predict the middle-class economic burden of Obamacare.
“It is also my understanding that total out of pocket medical expenses cannot exceed 10K per year, not including the cost of the premium. The two figures combined equate to 21K per year in total medical expenses for a given calendar year or roughly 24% of the family’s total income.”
The following is a comment I posted to Mr. Katz blog in August 2009, and references the fact that if you are ineligible for premium subsidies, your out-of-pocket expenses could total 24% of your income.
I am a simple layperson, yet apparently, at least, according to your article, I was able to correctly predict the middle-class economic burden of Obamacare.
“It is also my understanding that total out of pocket medical expenses cannot exceed 10K per year, not including the cost of the premium. The two figures combined equate to 21K per year in total medical expenses for a given calendar year or roughly 24% of the family’s total income.”
4
Obama Care is like the Tower of Babel. In 2009 President Obama had 60 democrat votes in the senate and a democrat majority in the house, he had no idea how to build a world class medical system that would cover nearly everybody. President Obama had only one skill and that was political. He could have had anything, but he chose an area that he knew little if anything about. After making political deals with nearly every democrat, he realized that he did not need any republicans. He cobbled together a Frankensystem built on a foundation of broken systems that covered 85% of the population. This monstrosity now covers 90% of the population. It has separated people from their doctors, their plans, and their ability to stay healthy. The only answer for the long term is to repeal and replace. Some things can't be fixed. Buildings that have outgrown their highest and best use are torn down to properly build a new building.
8
We have a small business and have had to buy insurance for years. Ten years ago the insurance we got that covered us and a few employees was better. It cost less, had no deductibles and covered better. Now we have a big deductible and higher copayment. It takes more of our income and we can't afford to cover all our employees fully. It got much worse after the ACA was passed. What happened to the cost savings promised when the ACA act was being passed. It certainly has not happened.
8
So many countries do health care at affordable costs with better social outcomes than ours and we struggle year after year to make a boondoggle work.
Its like we're not even trying anymore. The answers surround us, but for some reason we have to make a mess of it because we need an "American solution".
Well America is failing. America gets an D-. We need to repeat the class.
Its like we're not even trying anymore. The answers surround us, but for some reason we have to make a mess of it because we need an "American solution".
Well America is failing. America gets an D-. We need to repeat the class.
9
Socialized anything has yet to work. Government is trying to destroy healthcare not fix it.
1
You are not correct. Statistically, anecdotally, factually, empirically or any way you want to describe it.
3
Insurance of any kind is a gambler's bet. The insurer bets it will not have to pay out and the insured bets he/she will be paid, if needed. I suspect most insureds hope fervently they will never need their paid for insurance...
5
Well said.
I wish the NYT would bring back Uwe Reinhardt to help us understand the economics of health care better. When health care is 18% of US GDP and rising, it is clear to me that it has come to resemble the defense industry, driven by the internal interests of the industry rather than the consumers.
But with such a large role on our economy, we need a long term plan to take as much as half of the cost out of the bloated system in steps rather than in a overnight change. An economist could better describe the effects of a sudden cut in payments implied by Medicare for all, on health care employment and investment.
First steps could be gradually lowering the age for Medicare eligibility buy-in, raising income level for Medicaid buy-in and expanded use of reference pricing in the employer market.
The biggest affordability issue with the ACA is for those in their 50s and early 60s who are just above the subsidy income cutoff, which is where Medicare expansion could be most effective.
Similarly, expanding Medicaid with a premium buy-in at income levels above the current 133% of the FPL would reduce subsidies of high cost private policies. In states that expanded Medicaid under the ACA, nearly 80% of the enrollment was for Medicaid rather than private plans.
But with such a large role on our economy, we need a long term plan to take as much as half of the cost out of the bloated system in steps rather than in a overnight change. An economist could better describe the effects of a sudden cut in payments implied by Medicare for all, on health care employment and investment.
First steps could be gradually lowering the age for Medicare eligibility buy-in, raising income level for Medicaid buy-in and expanded use of reference pricing in the employer market.
The biggest affordability issue with the ACA is for those in their 50s and early 60s who are just above the subsidy income cutoff, which is where Medicare expansion could be most effective.
Similarly, expanding Medicaid with a premium buy-in at income levels above the current 133% of the FPL would reduce subsidies of high cost private policies. In states that expanded Medicaid under the ACA, nearly 80% of the enrollment was for Medicaid rather than private plans.
13
I'm one of those folks who buy health insurance on the individual market. For me the Affordable Care Act is wildly misnamed -- about half of my income goes for health insurance and I've not been a hospital inpatient in about 30 years.
This column amounts to whistling in the dark, what is really needed is a program to reduce health care costs across the board for the vast majority of Americans.
This column amounts to whistling in the dark, what is really needed is a program to reduce health care costs across the board for the vast majority of Americans.
10
The hardest hit seem to be the working poor. I have a job in NYC and employer-based health care, but my hardworking rural friends in Pennsylvania who are self-employed or work several jobs, or have little income but own a home, tell me horror stories and can't afford plans, get kicked of plans, get Medicaid, get kicked out of Medicaid when they work, get scammed by con artists who pretend to be legitimate insurers. One young woman is having a baby and her doctor can't deliver it. They are frustrated, humiilated, and turned off, not only to the health-care system, but also to voting and trying to work at all. Pennsylvania needs to do better, but so do the insurers, as this article indicates. It is clear by now that America needs a single-payer system.
33
My daughter can't afford health insurance. She is just above the subsidy threshhold and to pay $2000 for insurance with such a high deductible that it is only a castastrophic protection plan doesn't make sense to her or fit in her budget. We need insurance that gives some kind of immediate benefits to people - something tangible.
6
What we DON'T need is insurance; we need healthcare.
4
People who condemn the ACA and its insurance price increases must have amnesia regarding the skyrocketing insurance costs pre-ACA. My costs tripled in about 10 years, and I was constantly nickeled and dimed on deductibles and copays.
The ACA will fail, and deserves to fail, because it tries to maintain an absurdly expensive layer of for-profit bureaucracy (insurance companies) that is in-turn duplicated in every doctor’s and dentists’ office in the country. It’s a huge burden of waste. While this is not the only reason for high medical costs, it’s a big factor. The overarching reason for skyrocketing medical costs is that the monetization of health has been corporatized both at the insurance level and the hospital and doctor level. Despite the compassionate doctors and nurses I deal with, I recognize that my family’s health is just another profit center for the organizations they are part of.
I run a small business. My ACA insurance (without subsidy) this year would be $30,000 for four of us, with a $10,000 deductible. No optical or dental. That’s not health insurance, it’s bankruptcy insurance. I would be happy to pay $10-15,000/year in taxes to have real health insurance. It’s time to go single payer, like virtually every other first world country.
The ACA will fail, and deserves to fail, because it tries to maintain an absurdly expensive layer of for-profit bureaucracy (insurance companies) that is in-turn duplicated in every doctor’s and dentists’ office in the country. It’s a huge burden of waste. While this is not the only reason for high medical costs, it’s a big factor. The overarching reason for skyrocketing medical costs is that the monetization of health has been corporatized both at the insurance level and the hospital and doctor level. Despite the compassionate doctors and nurses I deal with, I recognize that my family’s health is just another profit center for the organizations they are part of.
I run a small business. My ACA insurance (without subsidy) this year would be $30,000 for four of us, with a $10,000 deductible. No optical or dental. That’s not health insurance, it’s bankruptcy insurance. I would be happy to pay $10-15,000/year in taxes to have real health insurance. It’s time to go single payer, like virtually every other first world country.
58
The basic problem is that the hospitals have taken over outpatient care by buying up many of the physicians, so that much outpatient care takes place in the very expensive ultra hierarchical behemoth marble floored edifices, instead of in physicians offices. Thus they are paid hospital rates.
Most healthcare is outpatient, and is an interaction between a patient and a doctor, with some ancillary support and some testing. (The doctor cannot be replaced by a computer run by a nurse, as some would claim.) No need for a multilevel management structure with layers of multi-million a year executives. Hospitals and hospital employed physicians are paid up to 3 times more than private practitioners for identical services. And now, when it may be too late, studies have shown NO BENEFIT to the vertical integration and horizontal consolidation incentivised by ACA; to the contrary, increased costs and no quality improvement has been shown in studies.
What we need is hospitals to go back to treating patients who need to be hospitalized, and the society needs to go back to delivering outpatient care in the much lower cost environment of private practice. We as individuals can make a point of seeking private practitioners ..THE MOST IMPORTANT COST EFFECTIVE CHOICE IS A PRIVATE PRACTICE PHYSICIAN. In spite of the fact that it is hard to get prices in advance of treatment, you can always be sure that the private practice will be less costly than a hospital facility.
Most healthcare is outpatient, and is an interaction between a patient and a doctor, with some ancillary support and some testing. (The doctor cannot be replaced by a computer run by a nurse, as some would claim.) No need for a multilevel management structure with layers of multi-million a year executives. Hospitals and hospital employed physicians are paid up to 3 times more than private practitioners for identical services. And now, when it may be too late, studies have shown NO BENEFIT to the vertical integration and horizontal consolidation incentivised by ACA; to the contrary, increased costs and no quality improvement has been shown in studies.
What we need is hospitals to go back to treating patients who need to be hospitalized, and the society needs to go back to delivering outpatient care in the much lower cost environment of private practice. We as individuals can make a point of seeking private practitioners ..THE MOST IMPORTANT COST EFFECTIVE CHOICE IS A PRIVATE PRACTICE PHYSICIAN. In spite of the fact that it is hard to get prices in advance of treatment, you can always be sure that the private practice will be less costly than a hospital facility.
31
Bravo! Someone gets it!
See a Physician who takes cash only and see how much money you will save!
Buy insurance for catastrophic care only - that's how it should be.
See a Physician who takes cash only and see how much money you will save!
Buy insurance for catastrophic care only - that's how it should be.
6
The problem is people don't go to the doctor if they have to pay. Even the smallest co-pay is an obstacle. So, people will end up in the hospital with preventable catastrophes. Why do you think it costs so much to pay for the uninsured?
When everyone has a catastrophe, the price of catastrophic insurance goes through the roof.
When everyone has a catastrophe, the price of catastrophic insurance goes through the roof.
2
It should be obvious to everyone by now: competition does nothing to hold down costs in healthcare, and neither does reliance on private insurance companies. The only rational approach, although certainly not an overnight fix, is Medicare for everyone.
45
But what about those of us that are quite happy with our existing employer provided insurance? I'd rather keep my existing insurance than be shifted to Medicare which provides inferior insurance with smaller networks than my current program. No thanks!
2
The problem here is what they say in the first few bits - "they have to make money to pay claims" and then, "If everyone priced too low, they can just raise their prices in the future years...most won't notice a difference outside middle-class because of subsidies."
Really? The basics of any functioning market is to price accordingly not price so someone, anyone, can come in and pay for the misplacing. Of course it costs more than what was promised. Outside of an economic pro-universal health care group, every other economist said, "this is going to cost more than you realize."
When did the NYT throw the middle-class to the side of the street. As long as the poor are okay we don't mind dropping $660b for 2016 (CBO report March 24) to benefit 30,000,000 people - remember, the middle class here are carry their own weight and the affordable care act was to take care of those uninsured (the 30,000,000 - that is $20,000 per person.
Really? The basics of any functioning market is to price accordingly not price so someone, anyone, can come in and pay for the misplacing. Of course it costs more than what was promised. Outside of an economic pro-universal health care group, every other economist said, "this is going to cost more than you realize."
When did the NYT throw the middle-class to the side of the street. As long as the poor are okay we don't mind dropping $660b for 2016 (CBO report March 24) to benefit 30,000,000 people - remember, the middle class here are carry their own weight and the affordable care act was to take care of those uninsured (the 30,000,000 - that is $20,000 per person.
13
CBO estimates the net cost of ACA for 2016 at $110 billion, or $3667 per person, if spread among 30 million people.
This is from that 3/24/16 report: https://www.cbo.gov/publication/51385
All healthcare is subsidized in some way by the federal government. That's the estimated $660 billion.
This is from that 3/24/16 report: https://www.cbo.gov/publication/51385
All healthcare is subsidized in some way by the federal government. That's the estimated $660 billion.
3
One of the biggest chunks of that $660B is the tax exclusions for employer-sponsored health insurance (41%). That benefits almost half the population of the country all by itself.
2
"If everyone priced too low, they can just raise their prices in future years, and it’ll be O.K. That’s not great for middle-class people who pay their own premiums but most people in the exchanges won’t notice a difference because of the way the subsidies work."
Are you kidding me? If I switched to ObamaCare from my grandfathered health care plan, my rates would almost double. And now you are saying if they go higher, it's no big thing? I almost can't believe I read that with my own eyes. From those of us who won't be getting a subsidy, thanks for the caring. It does matter. Further, it violates the rights I used to have to just drop health care, if I wanted to.
Are you kidding me? If I switched to ObamaCare from my grandfathered health care plan, my rates would almost double. And now you are saying if they go higher, it's no big thing? I almost can't believe I read that with my own eyes. From those of us who won't be getting a subsidy, thanks for the caring. It does matter. Further, it violates the rights I used to have to just drop health care, if I wanted to.
38
When my Regence plan went up I called to find out why. Turns out that these insurance companies have no skin in the game and take no risks. If what they pay out is more than they take in, they raise the rates. So basically they are just middle men managers, and they are supposedly "non-profit", which makes me wonder what kind of taxes if any they pay. They wouldn't tell me how much salary their CEO makes, but digging around I found out he made $1.5 million for just 2 of the 4 states he manages. He is making a huge profit and my increased rates help pay for it. This is not right.
36
The problem is that the insurance companies are giant and the cost to administer them is truly expensive. If physicians wouldn't need to go through the insurance companies and have to negotiate with them and beg for there money every month then the cost would be cheaper. Nobody looks into this. BTW im in healthcare and the way the insurance companies regulate healthcare is outrageous. The insurance companies say they don't dictate patient care, but believe me (or if you are a patient you know this) insurance companies regulate patients healthcare decisions all the time.
18
Since I can't afford the Covered California premiums as things now stand, I guess I ought to look forward to them being raised even higher -- high enough, that is, to bump them just over the percentage of my income that will exempt me from having to pay an extra 2-1/2 percent tax for the crime of not being able to afford health insurance.
13
I love the comments here. People see the failure of a government policy to control prices, and indeed likely raise them, and decide that more government intervention is the solution.
12
@Hiller
1) you hear a lot fewer people complaining about Medicare than about their company or Obamacare insurance.
2) Every other developed country has more government "interference" and has significantly lower costs and higher satisfaction.
3) Any American who has experienced other systems, like Canada's or England's likes it better than the US system.
4) The current America Healthcare "system" is a messy kluge and so far intervention has consisted of another klugey patch to keep the thing from collapsing.
1) you hear a lot fewer people complaining about Medicare than about their company or Obamacare insurance.
2) Every other developed country has more government "interference" and has significantly lower costs and higher satisfaction.
3) Any American who has experienced other systems, like Canada's or England's likes it better than the US system.
4) The current America Healthcare "system" is a messy kluge and so far intervention has consisted of another klugey patch to keep the thing from collapsing.
4
That's rhetorical posturing on your part, not an argument. It's like saying that because a navy loses a battle, it can never win a battle, because, you know, it's part of the government.
2
Having health insurance is very different than having health coverage. Obamacare did help the very poorest (my family included) but it was too watered down by the time it passed to bring the changes needed. Paying hundreds a month with a big deductible makes you insured, but if you're like many Americans, it does not make health insurance even reasonably affordable. Even expanded contraception coverage, one of the better parts of the plan, is limited by the minutia of the bill. They do not have to cover every type of birth control, and if they're grandfathered in, they don't even have to cover birth control without a co pay. Having health insurance but not being able to afford to pay for care (maybe because you pay several hundred a month for the "insurance") leaves many without any choices or ability to see a doctor.
37
We need one overall centralized medical care system provided with tax dollars.
Everyone pays and everyone receives free care at the point of need.
Stop using sanitized versions of the only term applicable in the system which is "medical care" given through a physician's recommendation. "Health care" can be given by nurses with advanced degrees.
Cut down on brick and mortar institutions and share equipment according to population size. Centralize, standardize and simplify wherever possible. Above all, minimize the profit motive. The patient is the only one who counts...
Use successful models already out there in advanced countries.
RN
Everyone pays and everyone receives free care at the point of need.
Stop using sanitized versions of the only term applicable in the system which is "medical care" given through a physician's recommendation. "Health care" can be given by nurses with advanced degrees.
Cut down on brick and mortar institutions and share equipment according to population size. Centralize, standardize and simplify wherever possible. Above all, minimize the profit motive. The patient is the only one who counts...
Use successful models already out there in advanced countries.
RN
15
Nurses cannot supply Medical Care or Health Care.
They can only supply Nursing Care - no matter what type of "advanced" degree they hang on the wall. They have a license to practice Nursing and nothing else.
They can only supply Nursing Care - no matter what type of "advanced" degree they hang on the wall. They have a license to practice Nursing and nothing else.
2
All these discussions are moot issues, the Obama Care has failed, it failed miserably. USA will have to go to the system that which Senator Sanders, or Mr.Trump might propose -- extend the Government take over to cover every aspect of medical health. Why on Earth, do we need to continue the failed medical system in the richest and most prosperous country?
9
Professor Gruber and the law's other architects knew that that for "the numbers to work" employers would have to be pressured into eliminating or degrading their employees' policies, which would force those employees to turn to the exchanges where their premiums would help to subsidize coverage for people who are poorer and, on average, sicker.
7
The primary reason that our healthcare system is so expensive is because of our third party payer system. People are not exposed to the true costs of their care. Hospitals and doctors get to literally make up prices, and see if the insurance payer flinches or not. If they don't flinch, we'll raise the prices some more, until they do flinch. I work in healthcare by the way. Once you hit your deductible, there is no disincentive to see the doctor as much as you want. Many meds are heavily subsidized too. Until people see more of the costs of treatment, not less - the national healthcare bill will continue to rise. At some point our entire economy will be dedicated to healthcare. Why stop at $3 Trillion? Single-payer may help in negotiating reimbursement levels, but there is no guarantee there either. We couldn't impose cost controls during the Medicare Part D implementation, so I have no faith that Bernie will work any special deal either. I would say get ready for more taxes & slower salary growth due to increased HC costs.
8
Living in a country where you do not have to pay anything after you reach a certain maximum (in my case, about $5000 a year), I fail to see how always having insureds pay something would really discourage someone from going to the doctor. If you are sick, you are sick, and putting off that visit might be more expensive in the long run. Not taking care of little problems today (high blood pressure, cancer in early stages) can be very expensive a few years down the road, and is not limited to medical expenses, but often has federal disability pensions, unemployment payments, etc. associated with it.
Since going to the doctor has its own, non-monetary costs (time, having things stuck into you, having to get undressed in front of others), I doubt that anyone really goes to the doctor just "for fun".
Since going to the doctor has its own, non-monetary costs (time, having things stuck into you, having to get undressed in front of others), I doubt that anyone really goes to the doctor just "for fun".
2
When Obama was first running for president, he was talking about a single payer health care system to provide health care for the nation. That turned out to be just talk. He quickly caved to the big insurance companies, And, now we are where we are now.
Bernie Sanders argues that we can have universal health care systems like they do in the European countries at half our present cost. If the peoples of Europe can do this, why can't We the People of the United States do this as well?
Bernie Sanders argues that we can have universal health care systems like they do in the European countries at half our present cost. If the peoples of Europe can do this, why can't We the People of the United States do this as well?
55
interesting question, but do know that England now is asking for a private system to compete with the public system because the public system is so inefficient. The person asking for this private system is actually the Minister of Health.
3
The UK already has a private system that competes with the NHS. About 10% of population buys private health insurance and gets their care in the private system. This has been true ever since the NHS was established in 1948.
7
DG, don't you know the Minister of Health is a free-market ideologue like all the other Conservative ministers?
2
Overlooked in this debate is the fact that if we had a functional political environment, we could revisit the ACA to make necessary improvements. Nobody said it was going to be perfect or that it wouldn't require tweeking to make it work better. But that option is off the table thanks to fanatical and mindless Republican opposition.
Devising a private insurance system that covers and is affordable for everyone is hard work and generally requires more regulation not less - the experience of other countries confirms that. This is why Republicans still have no substantive plan of their own despite the fact that we're now into the 8th year of Obama's presidency.
Devising a private insurance system that covers and is affordable for everyone is hard work and generally requires more regulation not less - the experience of other countries confirms that. This is why Republicans still have no substantive plan of their own despite the fact that we're now into the 8th year of Obama's presidency.
33
When I read the comments by the reporters and the readers it's clear - the problem with the ACA is it created winners and losers. That was the flaw in its design and that is why no one can predict how successful it will be going forward. Just too many angry middle-income people who got burned.
I supported the law and its promise of "affordable healthcare for all". We all know that the ACA failed in delivering on that promise. However we slice and dice the data, it's clear that low income, previously uninsured people and those with chronic and/or pre-existing conditions benefited. It's equally clear that many who had insurance before. whatever their age and were healthy, are paying more and often unable to use the insurance they have.
Healthy older people were particularly hard hit because they did not benefit from many of the new essential health benefits (childbirth and coverage for children up to age 5, dental and vision for kids up to age 18) and they are paying two to three times as much. The law allowed those under 30 to qualify for catastrophic coverage but denied that option to older Americans. If you are 60 years old and not subsidy eligible you could be paying as much as $600 in premium and carrying a $6,000 deductible for the same catastrophic plan a 25 year old enjoys.
I suspect this was all done to encourage young, healthy people to sign up. But like the prevalence of Medicaid managed care company HMO's it's a problem that we need to address.
I supported the law and its promise of "affordable healthcare for all". We all know that the ACA failed in delivering on that promise. However we slice and dice the data, it's clear that low income, previously uninsured people and those with chronic and/or pre-existing conditions benefited. It's equally clear that many who had insurance before. whatever their age and were healthy, are paying more and often unable to use the insurance they have.
Healthy older people were particularly hard hit because they did not benefit from many of the new essential health benefits (childbirth and coverage for children up to age 5, dental and vision for kids up to age 18) and they are paying two to three times as much. The law allowed those under 30 to qualify for catastrophic coverage but denied that option to older Americans. If you are 60 years old and not subsidy eligible you could be paying as much as $600 in premium and carrying a $6,000 deductible for the same catastrophic plan a 25 year old enjoys.
I suspect this was all done to encourage young, healthy people to sign up. But like the prevalence of Medicaid managed care company HMO's it's a problem that we need to address.
39
I appreciate your succinct appraisal, it is spot on for my situation. At age 60, with no chronic health issues, I now pay $452 per month for individual health insurance on the Exchange, with a $6000 deductible. After two years of coverage, I have not filed a single claim due to the high deductible and have paid all health expenses out of pocket, in addition to the ridiculously high premium each month. Am I blessed with good health? Yes. Am I being penalized for being a healthy, middle income, self-employed older American? Absolutely. Because my premiums have increased more than $100/month in two years, I may drop coverage if they increase this year.
22
Bingo.
4
So why aren't you filing claims? Early in a given year you wouldn't know you were going to have a severe problem which would push you past the deductible. It's also been my experience that drugs will cost me less if I buy them thru the insurance system, even if I'm under my deductible because the insurance company has negotiated a discount. Perhaps you negotiate with your medical providers on your own and get as large a discount as your insurance company does. Or perhaps you're shooting yourself in the foot by not submitting claims. Also, under the individual insurance I've had various preventative services were available at no cost to me.
3
The individual insurance market is 19 million people. 155 million people are covered in the employer insurance market. Employers have been driving health care policy for some time and will continue to do so.
Just as employers have made employees self-fund most of their pensions, they have been making employees pay more and more of their healthcare costs. Employers will probably continue to do this until the majority of employees pay all of their health costs and the employer only offers catastrophic coverage.
Insurers are not driving this. They want to sell more coverage, not less. It is the employer who wants to buy less coverage.
Under Obamacare, only (a very vocal) 13% of enrollees do not get subsidies. We'd save a lot of time and argument if we just paid them subsidies, too. All of the polarizing argument about Obamacare just distracts us from pursuing real solutions to our broken health coverage approach.
Just as employers have made employees self-fund most of their pensions, they have been making employees pay more and more of their healthcare costs. Employers will probably continue to do this until the majority of employees pay all of their health costs and the employer only offers catastrophic coverage.
Insurers are not driving this. They want to sell more coverage, not less. It is the employer who wants to buy less coverage.
Under Obamacare, only (a very vocal) 13% of enrollees do not get subsidies. We'd save a lot of time and argument if we just paid them subsidies, too. All of the polarizing argument about Obamacare just distracts us from pursuing real solutions to our broken health coverage approach.
3
I'm not familiar with your data but assume it is accurate and that we can assume 13% of those who buy insurance through a state or federal exchange are not subsidy eligible. That does seem like a small number.
But, the vast majority of middle income people who do qualify for subsidies are not buying insurance through an exchange unless they live in California or New York where they are required to do so.
There are likely an equal number of people buying on the individual market directly from insurers or through brokers as are purchasing through the exchanges - 8, 9, 10 million or more.
There are a lot more ACA "losers" out there.
But, the vast majority of middle income people who do qualify for subsidies are not buying insurance through an exchange unless they live in California or New York where they are required to do so.
There are likely an equal number of people buying on the individual market directly from insurers or through brokers as are purchasing through the exchanges - 8, 9, 10 million or more.
There are a lot more ACA "losers" out there.
3
Do you have actual statistics of where only 13% of enrollees do not receive subsidies? That is a lot smaller of a percentage than I have seen.
1
The recent CBO report on federal healthcare subsidies estimates that of the 13 million who purchased insurance through the nongroup marketplace, 10 million received subsidies. That's 23% who didn't receive subsidies in that way.
But the same report emphasizes that most healthcare in the US is federally subsidized in one way or another.
https://www.cbo.gov/publication/51385
But the same report emphasizes that most healthcare in the US is federally subsidized in one way or another.
https://www.cbo.gov/publication/51385
Unfortunately, the health providers and the insurers are complicit in high provider costs and insurance premiums.
Take this one small, but very broad-based example.
The annual health check up blood test.
Each year, ACA plans call for a healthy check up as part of the insurance provided payments. And in all cases, this will include a blood test.
I just had mine. Standard blood panel.
$613.53 was billed to the insurer who paid $495.97.
Even though this was free because it was part of the healthy check up charge, I contacted a local lab and the same blood test panel was $299.00.
Difference versus what the insurer actually paid for this one test is $196.97 .
Not a high amount of money until it is multiplied by say 250 million healthy blood test conducted each year. The total for this excess payment runs $49.2 BILLION per year.
Both the insurance companies and the health providers need to justify this fee structure. And since Uncle Sam is subsidizing premiums, justification should be demanded.
(BTW- the blood was shipped 200 miles and tested by a large national firm in Kansas City. The lab pricing was also from a national facility less than 1 mile from the hospital medical complex where the exam took place).
Take this one small, but very broad-based example.
The annual health check up blood test.
Each year, ACA plans call for a healthy check up as part of the insurance provided payments. And in all cases, this will include a blood test.
I just had mine. Standard blood panel.
$613.53 was billed to the insurer who paid $495.97.
Even though this was free because it was part of the healthy check up charge, I contacted a local lab and the same blood test panel was $299.00.
Difference versus what the insurer actually paid for this one test is $196.97 .
Not a high amount of money until it is multiplied by say 250 million healthy blood test conducted each year. The total for this excess payment runs $49.2 BILLION per year.
Both the insurance companies and the health providers need to justify this fee structure. And since Uncle Sam is subsidizing premiums, justification should be demanded.
(BTW- the blood was shipped 200 miles and tested by a large national firm in Kansas City. The lab pricing was also from a national facility less than 1 mile from the hospital medical complex where the exam took place).
66
Your article is more persuasive that we need government run single payer.
94
The trouble is that the vast majority of people with employer based coverage need to be persuaded that they would be better off with single payer, and many other large interests would need to be co-opted to make it happen. Plus 4 decades of ERISA based insurance rules would need to be overturned.
The political process that produced ACA was actually optimal for Democrats, with 60 Senators and a majority in the House.
Even if we need single payer, it isn't going to happen.
Instead price controls at all market levels are the best we can hope for. That includes consumers paying for insurance, and care providers paying for drugs and other supplies, as well as other markets.
Start with the pharmaceuticals.
The political process that produced ACA was actually optimal for Democrats, with 60 Senators and a majority in the House.
Even if we need single payer, it isn't going to happen.
Instead price controls at all market levels are the best we can hope for. That includes consumers paying for insurance, and care providers paying for drugs and other supplies, as well as other markets.
Start with the pharmaceuticals.
1
ACA is the most inefficient system of any of our peer countries re health care.
Having said that it is light yrs better than our previous republican de facto criminal plan or be rich or don't get sick or have a bad life event.
Better to go to a system like Canada or any number of systems our peer countries have that are much better than ACA...
Having said that it is light yrs better than our previous republican de facto criminal plan or be rich or don't get sick or have a bad life event.
Better to go to a system like Canada or any number of systems our peer countries have that are much better than ACA...
34
There is no "rational market" for healthcare because healthcare does not operate like a traditional commodity. You don't shop around for a cardiac surgeon during a heart attack; you don't go hospital-hopping when you've sliced your finger; you can't even get a straight answer about prices of tests and procedures if you wanted them.
The fantasies upon which mainstream economics are built never cease to amaze me. All of the complexity of the real world is regarded as a mere externality to a perfectly functional system. And we must have faith--for it will starting working any day now!
If you want to know why a large section of the population is angry, just look at the bounty and security promised by the capitalist priests...and then see how much capital has actually delivered.
The fantasies upon which mainstream economics are built never cease to amaze me. All of the complexity of the real world is regarded as a mere externality to a perfectly functional system. And we must have faith--for it will starting working any day now!
If you want to know why a large section of the population is angry, just look at the bounty and security promised by the capitalist priests...and then see how much capital has actually delivered.
73
There is a perfectly "rational" market if you only are in the top 1%. In that case, you will never pay a cent for health care. You are already on the best free health plan available in the world. Along with the company provided car, house, travel, etc.
4
Odd perspective. The reporters fret that as to " people just above the income cutoff for subsidies", "Analysts from the Urban Institute have done the math and found that some of them are paying more than 25 percent of their income on health care"
Above the level for subsidies = 1 person $47,100+++; 2 people $64000++, 3 people $80,400++, 4 people = $97,000 That is 400%+ Poverty Level for those size households
These are incomes that are in the top incomes for a worker. (MEDIAN -50% make more, 50% make less - worker makes $27,600 -'average' wages are $40000ish because of the skewing of wages to the top 10%)
Now go to that paper they cite.
Of course in the SAME study, it shows that the top 10% in each are also paying huge percentages of their income for premiums & out-of-pockets
Below 200% FPL 17.3% of income
200- 300% FPL 20.6% of income
300-400% FPL 20.6% of income
400% FPL 25% of income
OVER 500% 22.2% of income
So among the top 10% of spenders on healthcare in each income group, who has more left to live on?
The couple with an income of $72000 who spend $18000 on premiums & out-of-pockets -leaving them $54000 a year?
Or the waitress making $21000 a year who spent $3570 on premiums & out-of-pockets -leaving her $17430 a year?
ANd over-65 on Medicare -for a couple at average retirement income $37000+/- of (237% FPL) - JUST PREMIUMS typically take 21% of income & deductibles make it 28% of income.
Above the level for subsidies = 1 person $47,100+++; 2 people $64000++, 3 people $80,400++, 4 people = $97,000 That is 400%+ Poverty Level for those size households
These are incomes that are in the top incomes for a worker. (MEDIAN -50% make more, 50% make less - worker makes $27,600 -'average' wages are $40000ish because of the skewing of wages to the top 10%)
Now go to that paper they cite.
Of course in the SAME study, it shows that the top 10% in each are also paying huge percentages of their income for premiums & out-of-pockets
Below 200% FPL 17.3% of income
200- 300% FPL 20.6% of income
300-400% FPL 20.6% of income
400% FPL 25% of income
OVER 500% 22.2% of income
So among the top 10% of spenders on healthcare in each income group, who has more left to live on?
The couple with an income of $72000 who spend $18000 on premiums & out-of-pockets -leaving them $54000 a year?
Or the waitress making $21000 a year who spent $3570 on premiums & out-of-pockets -leaving her $17430 a year?
ANd over-65 on Medicare -for a couple at average retirement income $37000+/- of (237% FPL) - JUST PREMIUMS typically take 21% of income & deductibles make it 28% of income.
6
All of this handwringing over Insurors' profit and small pools with multiple players, crappy coverage and big premiums.
It's spelled Single-payer, and Bernie Sanders will explain it to everyone from the Oval Office.
It's spelled Single-payer, and Bernie Sanders will explain it to everyone from the Oval Office.
61
The way our government works now single payer will be a disaster. Explain the VA. I had to use the military system, supposedly a great one. Not so much. Since I was family member my care was always second to active duty. Since the pay for docs is so low and benefits not so great, like moving all the time, living in substandard housing on post, maybe being posted to a war zone, etc., specialists were thin on the ground and it was very difficult to see one. On top of that the pharmacy rules on medication meant that they may not use the meds you need. The system works great if you're healthy. If you're really sick, not so much.
7
And you are thinking that the Republican-controlled Congress will listen?
In public health, as in so many other areas of life, we all do better when we all do better. Expanded, improved Medicare For ALL -- Demand it.
54
Suggestion for Reed and Margot: try buying your own family's health
insurance for, say, three years in a row. You would find that every single
key variable -- coverages, deductibles, in-system and out-system definitions, among others, all change each year. It's impossible to renew a policy with only a change in premium.
The customer essentially is faced with trying to find the queen of hearts in a game of three-card monte. Genuine comparative shopping is impossible.
I have hit on the expedient of adding the deductible to the premium in order to see what the true cost of a policy would be if the insurance actually were needed -- if a claim had to be filed. Using this method,
I have found that roughly $25,000 in after-tax spending is needed to
cover a family of three. [If you are not going to need the insurance, you
are better off not buying it at all, and paying the fine.]
I have to ask: why bother with trying to sort out insurance companies' individual weaknesses and strengths? Why not just expand Medicare to
all citizens?
insurance for, say, three years in a row. You would find that every single
key variable -- coverages, deductibles, in-system and out-system definitions, among others, all change each year. It's impossible to renew a policy with only a change in premium.
The customer essentially is faced with trying to find the queen of hearts in a game of three-card monte. Genuine comparative shopping is impossible.
I have hit on the expedient of adding the deductible to the premium in order to see what the true cost of a policy would be if the insurance actually were needed -- if a claim had to be filed. Using this method,
I have found that roughly $25,000 in after-tax spending is needed to
cover a family of three. [If you are not going to need the insurance, you
are better off not buying it at all, and paying the fine.]
I have to ask: why bother with trying to sort out insurance companies' individual weaknesses and strengths? Why not just expand Medicare to
all citizens?
109
"If you are not going to need the insurance, you are better off not buying it at all"
That's always true. Of every form of insurance. By definition. If only we knew ahead of time if we were going to need our insurance or not...
As for Medicare: Sanders has disappointed me by not proposing - as a step towards single-payer - reducing the eligibility age for Medicare to 60. Incrementalism has its advantages - to whit, the possibility of actually making progress, one step at at a time, like an adult.
That's always true. Of every form of insurance. By definition. If only we knew ahead of time if we were going to need our insurance or not...
As for Medicare: Sanders has disappointed me by not proposing - as a step towards single-payer - reducing the eligibility age for Medicare to 60. Incrementalism has its advantages - to whit, the possibility of actually making progress, one step at at a time, like an adult.
5
It's time to cut costs. If actual medical care is unaffordable, what good are various schemes of payment?
Instead of insurance companies competing, we need doctors and hospitals to compete on price. Their cost structures are simply much too high for resources available to the average person, and they need to reform and make medical care cheaper.
Instead of insurance companies competing, we need doctors and hospitals to compete on price. Their cost structures are simply much too high for resources available to the average person, and they need to reform and make medical care cheaper.
34
I'm 58 going on 59, and my wife is 62. We're both in great health, and we're both self-employed. Our heath insurance premiums tripled under Obamacare. Yes, I said tripled. Our premiums are three times higher than they were. You can't convince me that Obamacare is good, because it isn't. It's nothing more than the middle class insureds providing nearly unlimited subsidization to people who are uninsured.
All this nonsense about Obamacare forcing prices lower by lowering premiums is just that ... nonsense. It's created by people who don't really understand economics.
If you want to make health care more affordable for everyone, you have to stop pumping money into it. Pumping money in drives the cost up, not down. Take money out of the system overall, and not just at the insurance level, you'll have a chance. Of course, the only way to do that is to get rid of all the patent laws, FDA, CDC, all regulation, and all of the other various ways that government has intruded on the medical marketplace that drove the cost up in the first place.
Plus, at some point you have to start encouraging real health. Calling sickness care "health care" is Orwellian double-speak that doesn't actually accomplish anything. The UConn Health Center near our home has grown to gargantuan proportions, but that's not an indication of greater health. Rather, it's an indication of greater sickness among the population in our area.
I'd say more, but I've reached my 1500 character limit on this board.
All this nonsense about Obamacare forcing prices lower by lowering premiums is just that ... nonsense. It's created by people who don't really understand economics.
If you want to make health care more affordable for everyone, you have to stop pumping money into it. Pumping money in drives the cost up, not down. Take money out of the system overall, and not just at the insurance level, you'll have a chance. Of course, the only way to do that is to get rid of all the patent laws, FDA, CDC, all regulation, and all of the other various ways that government has intruded on the medical marketplace that drove the cost up in the first place.
Plus, at some point you have to start encouraging real health. Calling sickness care "health care" is Orwellian double-speak that doesn't actually accomplish anything. The UConn Health Center near our home has grown to gargantuan proportions, but that's not an indication of greater health. Rather, it's an indication of greater sickness among the population in our area.
I'd say more, but I've reached my 1500 character limit on this board.
36
I'm sorry that it is not working for you and your family.
Everyone I speak to who has insurance through the ACA (especially in States that have their own exchange) are very happy and very thankful.
Those that have insurance in States that do not have their own exchange are a bit more problematic but they are still happy having something rather than nothing.
And btw, how many decades do we need to prove that certain things in our society should Not be for profit? The ACA addresses an out of control "for profit" health care industry. It is not perfect but until health or education is Not For Profit we need something.
Everyone I speak to who has insurance through the ACA (especially in States that have their own exchange) are very happy and very thankful.
Those that have insurance in States that do not have their own exchange are a bit more problematic but they are still happy having something rather than nothing.
And btw, how many decades do we need to prove that certain things in our society should Not be for profit? The ACA addresses an out of control "for profit" health care industry. It is not perfect but until health or education is Not For Profit we need something.
15
My daughter can tell you another side to how bad the ACA is and she has a subsidy! Besides the awful computer system (honestly no one went to jail for this on the government side?), it will not recognize that she has turned in all her paperwork and that she is not married. AS for healthcare, what a joke. It's basically catastrophic care. None of the docs she used to go to are in the system and even then the deductible is so high it will cost her a fortune to use it. It is not better.
13
You really, really must be kidding. Formerly uninsured in
upstate NY are very unhappy, many simply pay the fine and
use the emergency room if needed, just as they did before.
From their perspective, the fine is a new burden -- or, the
paperwork to get the credit is a new burden. For many of us,
just filling out forms is a kind of special torture.
Previously insured who make their own purchases, and even
employees getting employer insurance, are perplexed and
overwhelmed by trying to make reasonable choices when
the range of choices keeps being upended and there are no
common-sense standards consumers can use to review options.
upstate NY are very unhappy, many simply pay the fine and
use the emergency room if needed, just as they did before.
From their perspective, the fine is a new burden -- or, the
paperwork to get the credit is a new burden. For many of us,
just filling out forms is a kind of special torture.
Previously insured who make their own purchases, and even
employees getting employer insurance, are perplexed and
overwhelmed by trying to make reasonable choices when
the range of choices keeps being upended and there are no
common-sense standards consumers can use to review options.
4
United's market share in GA was about 4.5% and smaller than that in AK where they allegedly sold only about 600 policies on the exchange. There remain 8 other participating insurers in GA and 4 in AK. In other words a non event.
9
Sadly, for the self-employed who make too much to qualify for a subsidy but are by no means wealthy, the only plans available on the private market, at least in CT, cost a minimum of about $7000 per year for a policy that covers nothing but one checkup - no prescriptions, no doctor visits - until upwards of $7000 has been spent out of pocket. (When the insured is healthy, that's one heck of a return for the insurer.) Get sick at the end of the year? Another $7000 please, oh plus your premium. These are glorified and expensive catastrophic plans, nothing more.
72
I have been out of work over a year and a half now. Last year or policy was horrendous based on the income that I had had. We are still paying off the copays and will be for years. This year, being that our income shows a lot less on our taxes we got a slightly better plan. But that is only because we qualified for more tax rebates on the premiums. Remember, I said slightly better.
I truly hope that somewhere we as a Nation find a happy medium.
I truly hope that somewhere we as a Nation find a happy medium.
20
DL: Try shopping rather than posting misinformation.
37 plan options are listed on AccessHealthCT for Monroe, CT. None of them have a $7,000 deductible - the highest is $6,200 with a premium or $526/mth (age 55), and the most you could pay out-of-pocket is $6,550. So, if you had an accident or any illness that required hospitalization, others would be picking up tens of thousands of dollars of your costs.
But shop a little and you will see there are better options. If you don't want to pay much out of pocket there is $500 deductible Silver plan with a premium of $682/mth
Try thinking "the glass is half full" rather than trying to make us think "the glass is half empty"
Think about the fact that you would be putting your small business at risk if you did not have insurance and had a serious accident or illness
Last, think about the anxiety uninsured people had to live with before Obamacare
37 plan options are listed on AccessHealthCT for Monroe, CT. None of them have a $7,000 deductible - the highest is $6,200 with a premium or $526/mth (age 55), and the most you could pay out-of-pocket is $6,550. So, if you had an accident or any illness that required hospitalization, others would be picking up tens of thousands of dollars of your costs.
But shop a little and you will see there are better options. If you don't want to pay much out of pocket there is $500 deductible Silver plan with a premium of $682/mth
Try thinking "the glass is half full" rather than trying to make us think "the glass is half empty"
Think about the fact that you would be putting your small business at risk if you did not have insurance and had a serious accident or illness
Last, think about the anxiety uninsured people had to live with before Obamacare
5
In good old San Francisco, which has to be as expensive as Connecticut, if not more so, $860/month (at age 55) gets you a $0 deductible plan with either Kaiser or Blue Cross. The subsidies are generous at lower incomes, but do fade out quickly. Essentially, the complaint is that the subsidies are not high enough.
Hint: you game the system by finding an large employer with insurance that does not age rate, then between COBRA (18 months), and Cal-Cobra (another 18 months on top of that in California), you pay the non-age rated employer premiums for three years. Get job, qualify for COBRA, quit job. Repeat every three years. People do it.
Hint: you game the system by finding an large employer with insurance that does not age rate, then between COBRA (18 months), and Cal-Cobra (another 18 months on top of that in California), you pay the non-age rated employer premiums for three years. Get job, qualify for COBRA, quit job. Repeat every three years. People do it.
5