Why do we still listen to RAND? They've been so wrong so many times! We need another source of predictions.
Will someone please tell me which side of the male brain came up with 'deductibles' and 'co-pays'? These are like being charged an entry and exit fee every time you pass through the door of your rented apartment. They are the #1 barrier to actual preventive care.
Here's how it should be: No insurance companies, but health-care cooperative membership, whose fees are no more than 5% of workers' wages. No deductible. No co-pay. Management salaries capped at 50% of that of the President of the United States: if you're not smart enough to live on that, you're not qualified (indeed the best hospital CEO I ever saw was a nun). That would weed out the riffraff, and downsize this corporate "mine is bigger" empire of excess - and make our hospitals and clinics the lean, mean fighting machines they once were. The best thing to do would indeed be repeal the 'you gotta buy it' mandate of the ACA - which is now like forcing people to buy huge honking gas-guzzling SUVs when most of us want to ride bikes or walk. And maybe ask patients how much they think is fair to pay for health care: you cannot have patient-centered care without patient-centered economics. Oh and please fix the raging-hormone problem that is now endemic in the 'industry' - you know the one I mean!
Here's how it should be: No insurance companies, but health-care cooperative membership, whose fees are no more than 5% of workers' wages. No deductible. No co-pay. Management salaries capped at 50% of that of the President of the United States: if you're not smart enough to live on that, you're not qualified (indeed the best hospital CEO I ever saw was a nun). That would weed out the riffraff, and downsize this corporate "mine is bigger" empire of excess - and make our hospitals and clinics the lean, mean fighting machines they once were. The best thing to do would indeed be repeal the 'you gotta buy it' mandate of the ACA - which is now like forcing people to buy huge honking gas-guzzling SUVs when most of us want to ride bikes or walk. And maybe ask patients how much they think is fair to pay for health care: you cannot have patient-centered care without patient-centered economics. Oh and please fix the raging-hormone problem that is now endemic in the 'industry' - you know the one I mean!
Why don't we admit that co-pays and deductibles are bad ideas to start with, whose original intent was to discourage people, especially poor people, from going to the doctor "too much"? Every study I've ever seen tells us that while a few people may go to the doctor unnecessarily -- and even that's in the eye of the beholder -- a lot more people don't go to the doctor when they should. Any "incentive" co-pays and deductible produce is a perverse one, and it's time we outgrew it as a nation. Why pay for health care twice or more, once in your premium and then again through deductibles and co-pays, when you can pay for it just once, through your premium?
14
What is it about you Americans that it is simply impossible for you to do what the rest of the civilized world did decades ago, providing universal, high-quality affordable health care insurance from cradle to grave? What is wrong with you people? Is this American Exceptionalism?
30
Thank you, Dr. Carroll, for sharing these insights now, 6 or so years after the ACA was implemented, and a few weeks after the election was held. At this point, it hardly matters what Mrs. Clinton suggested, don't ya think?
7
All of this is about putting a band-aid on a gunshot wound. None of this addresses the systemic problem of runaway healthcare costs that are now resulting in the incorporation of practices where many formerly independent practices are joining a few large corporate entities to make more profits. We now have a medical industrial complex to add to Eisenhower's military industrial complex, and like all such arrangements, it exists to feed off of the population, not to serve it.
I have excellent medical coverage that costs me $50 a month with a $5 co-pay. Why? Because it's an industry health plan that was set up decades ago as a non-profit to SERVE the population. And for most of my working life I paid NOTHING in premiums because the plan could offer coverage as a NON-PROFIT! We'll see an increase in premiums, but it will be nothing like what others are being forced to pay to a profit hungry racket that has become the new medicine.
I have excellent medical coverage that costs me $50 a month with a $5 co-pay. Why? Because it's an industry health plan that was set up decades ago as a non-profit to SERVE the population. And for most of my working life I paid NOTHING in premiums because the plan could offer coverage as a NON-PROFIT! We'll see an increase in premiums, but it will be nothing like what others are being forced to pay to a profit hungry racket that has become the new medicine.
24
man did you hit the backside of a lot bodies with your comment my plan is employer provided where i spend 74 bones a month which parenthetically covers me and the Misses and withheld weekly out of my check. the only problem i'm forced to stay on the payroll probably late into my 60's because if i chose to retire, then I'm hit, Medicare will be limited. The ACA as it appears will be a thing of the past. But old Paul Ryan (PR) wants to keep it that way for me. his point is that if you want insurance just work to the day you croke and remain on your employers' health plan..less of a government burdened.
8
Dr. Carroll still doesn't get it. One minute he says, "To argue suddenly that people should be shielded from the expense of health care would be a sea change for conservative health insurance design." only to follow up with a proposal that waves cop-pays and deductibles for the people who spend the most on healthcare.
At what point will he finally acknowledge that sick people are what drive up the cost of insurance, and conservative proposals for healthcare, some of which have been incorporated into the ACA all involve having sick people shoulder MORE of the costs of their illnesses, not less.
What on earth do you think high deductible high copay policies are designed to do, if not put more burdens on sick people? Who believed that in telling people to buy the insurance that's right for them they would take into account illnesses or accidents that they never anticipated? Who believed that calling high deductible policies "affordable" when in fact they were being bought by the people who can least afford unexpected healthcare bills was going to be good for them?
The people have been failed. Failed by Obama, who refused to address the brewing crisis in employer based healthcare, failed by economists who repeated the lie that Americans use too much healthcare, and used it to justify reform that makes it harder for people who traditionally use too little healthcare to get it, and failed by the medical community who refused to take a stand on behalf of their patients.
At what point will he finally acknowledge that sick people are what drive up the cost of insurance, and conservative proposals for healthcare, some of which have been incorporated into the ACA all involve having sick people shoulder MORE of the costs of their illnesses, not less.
What on earth do you think high deductible high copay policies are designed to do, if not put more burdens on sick people? Who believed that in telling people to buy the insurance that's right for them they would take into account illnesses or accidents that they never anticipated? Who believed that calling high deductible policies "affordable" when in fact they were being bought by the people who can least afford unexpected healthcare bills was going to be good for them?
The people have been failed. Failed by Obama, who refused to address the brewing crisis in employer based healthcare, failed by economists who repeated the lie that Americans use too much healthcare, and used it to justify reform that makes it harder for people who traditionally use too little healthcare to get it, and failed by the medical community who refused to take a stand on behalf of their patients.
16
Forget about out-of-pocket costs, Mr Price plans to just throw 20 million out from being covered at all. Trump is is going start a new business that makes sure people don't 'die in the streets', they will be dumped into Mexico.
9
I am among the most-screwed Obamacare participants in the nation: early 60s and healthy, no premium subsidy, and terrible provider panels despite abundant nearby health care resources.
Still, I'm grateful.
Pre-Obamacare, efforts to get individual coverage at any price were frustrating and ultimately fruitless; no one would insure me due to a long-ago-cured illness and I had to take a terrible job simply to get coverage.
Obamacare gave me and millions of other Americans who choose to be self-employed the freedom to do what we like without fear of being wiped out by medical bills. If it's true that the GOP cannot both preserve existing-condition eligibility and a mandate-free system, I'll dread my 2018 coverage options even more than I'm dreading my 2017 40% premium increase.
Still, I'm grateful.
Pre-Obamacare, efforts to get individual coverage at any price were frustrating and ultimately fruitless; no one would insure me due to a long-ago-cured illness and I had to take a terrible job simply to get coverage.
Obamacare gave me and millions of other Americans who choose to be self-employed the freedom to do what we like without fear of being wiped out by medical bills. If it's true that the GOP cannot both preserve existing-condition eligibility and a mandate-free system, I'll dread my 2018 coverage options even more than I'm dreading my 2017 40% premium increase.
23
I'm a 43 year old female and pay $480 monthly premiums and have a $6,000 deductible. In 2017, I will have to choose between keeping coverage as my premiums and deductible will both increase, and paying off the medical debt I accumulated this past year when I had a radical hysterectomy. I have played by all of the rules--I worked my way through college, earned advanced degrees, work full-time, live modestly--and a straightforward, medically necessary procedure, has brought me to my knees, both figuratively and literally. I am fast losing my remaining faith in us as a nation.
34
Obamacare made the situation in this country go from horrendous to very bad, and that is because some well-paid Senators got rid of the public option which was required to "keep the insurance companies honest." We now know that they are incapable of honesty, therefore, if we are smart, we should put into place Medicare for all and be done with it. The insurance companies and Big Pharma had their chance and blew it.
Instead, roughly 62,000,000 people voted against their own interests, and we are all going to lose what little we do have. Smart move, America.
Instead, roughly 62,000,000 people voted against their own interests, and we are all going to lose what little we do have. Smart move, America.
32
When I got life insurance, a nurse came to my house and did a full physical - hair sample, blood sample, everything. Upon the analysis, they confirmed that I was one of the healthiest 40-somethings alive: never smoked, no alcohol, healthy weight, low resting heart-rate. As a result, I got a really good deal on my policy. Why can't the same process be done for health insurance? We need to incentivize people to take care of themselves. Why should I pay the same rate as someone who treats his or herself like crap?
3
Because not everyone who is ill became ill by treating him or herself like crap? Because while some may have won the genetic lottery, not everyone has? Because you are one diagnosis away from being on the other side of your question? Because I was a healthy 47 year old woman one day and the next day I wasn't?
17
Walker, are you aware that insurers won't sell life insurance to some people at all?
Like people with genetic mutations that predispose them to cancer, or other diseases. Or perhaps people with juvenile diabetes.
I take it you also don't ride motorcycles, or engage in mountain climbing or work in other high risk fields.
Like people with genetic mutations that predispose them to cancer, or other diseases. Or perhaps people with juvenile diabetes.
I take it you also don't ride motorcycles, or engage in mountain climbing or work in other high risk fields.
4
Quote,
"The reason plans have deductibles is that research shows you’re less likely to spend your money than the insurance company’s money. "
No the reason plans have deductibles, is the Insurance Company wants to build in a disincentive for you to seek care. Better to have chest pains for a few nights, and not seek medical care because you have a $10,000 deductible.
Then when you finally call an ambulance, you require a surgical intervention that costs you (and the insurer) much more than if you had gone to the Hospital at the first chest pains..angina.
This is Conservative dogma, that high deductibles "save' money for the insurer. They don't want to pay for preventive care either; which will be the first thing Price will strip from the ACA. Why have zero deductible screenings for colon-rectal cancer, or Mammograms as mandated in the ACA? They just drive up costs for insurers.
"The reason plans have deductibles is that research shows you’re less likely to spend your money than the insurance company’s money. "
No the reason plans have deductibles, is the Insurance Company wants to build in a disincentive for you to seek care. Better to have chest pains for a few nights, and not seek medical care because you have a $10,000 deductible.
Then when you finally call an ambulance, you require a surgical intervention that costs you (and the insurer) much more than if you had gone to the Hospital at the first chest pains..angina.
This is Conservative dogma, that high deductibles "save' money for the insurer. They don't want to pay for preventive care either; which will be the first thing Price will strip from the ACA. Why have zero deductible screenings for colon-rectal cancer, or Mammograms as mandated in the ACA? They just drive up costs for insurers.
18
The idea that consumers can manage healthcare costs is ludicrous. Have you ever tried to find out what a medical test will cost BEFORE you get it? I have. They refuse to tell you, saying it's confidential information between the provider and the insurance company. Both the insurance company, the provider, and my doctor absolutely refuses to provide any costs.
My point is that the consumer has no knowledge of costs and hence, can't manage them.
We need laws forcing consumers to be told total (negotiated) cost and out of pocket cost BEFORE undergoing a procedure.
My point is that the consumer has no knowledge of costs and hence, can't manage them.
We need laws forcing consumers to be told total (negotiated) cost and out of pocket cost BEFORE undergoing a procedure.
5
..and this is a large part of what the ACA has achieved - one reason why it is so hated by the different constituencies noted above.
1
Grandma, you are right that lack of consumer transparency is a major part of the problem with healthcare costs. Unfortunately for all the talk of "letting the market drive costs down", no one seems to be willing to require the transparency the market requires to function.
8
Our representatives are bought by the "wealth care industry". They care not for we the people. When are we going to make a great noise, bang pots in the streets, refuse to play their game? If Donald really wants to Make America Great Again he can start with ensuring we measure up to much of the rest of the world in terms of what our health care costs and what our outcomes are.
At age 62, I am faced with premium increase of 90% from 2016 to 2017 for a crappy Bronze policy. My MAGI is a bit over the maximum for receiving a subsidy. I calculated that I will be better off cutting my hours of work next year by 35% to reduce my income, so I can get a subsidy, with which I can procure a MUCH better silver policy. I won't be able to continue to pay off old debt from the recession (but I wouldn't have been able to anyway, given the 90% increase). So I'll either go to CCCS to see if something can be negotiated to pay them off, or I'll file bankruptcy.
And BTW, husband and I have been counting the years until we hit 65 and can have Medicare, and now the fu(%er Ryan is going to come for that.
At age 62, I am faced with premium increase of 90% from 2016 to 2017 for a crappy Bronze policy. My MAGI is a bit over the maximum for receiving a subsidy. I calculated that I will be better off cutting my hours of work next year by 35% to reduce my income, so I can get a subsidy, with which I can procure a MUCH better silver policy. I won't be able to continue to pay off old debt from the recession (but I wouldn't have been able to anyway, given the 90% increase). So I'll either go to CCCS to see if something can be negotiated to pay them off, or I'll file bankruptcy.
And BTW, husband and I have been counting the years until we hit 65 and can have Medicare, and now the fu(%er Ryan is going to come for that.
25
Im an American living in the Ph . I simply want to share some of the standard cost for medical care here .
It cost about 12 dollars to see a doctor , the Pediatrican is only 6 dollars .
My little boy was in the hospital for a week with pneumonia in Sept and the
final bill was about 1500 dollars inclusive of medicatons and a private room .
An ultrasound cost about 20 bucks , an imaging machine ( to look for a kidney stone ) cost about 100 bucks , lab work for my blood and urine cost 6 dollars and i think the emergency room visit is 20 dollars . A hospital room is about 50 dollars / night ( cable and air conditioner. ) I have the telephone numbers of my doctors .
There are a great many very good doctors in town , the hospitals collect a deposit upon admission . The protocol here is to show up and to take a number and to wait without an appointment , i've never waited longer than an hour . I also think medication is less here also. Tramadol that i keep for kidney stones cost about 75 cents . It wouldn't make sense or be practical to move to another country for these reasons ( I did not get into dental care , but same deal , its a bargain and top notch . I just wanted to share this as i find it a big advantage in living overseas. Not to mention that my US based Health Insurance cost a lot less , 2500 bucks / year with an unlimited life time maximum and no out of pocket expense after i've spent a total of 13,500 for any one year . Thats all thanks
It cost about 12 dollars to see a doctor , the Pediatrican is only 6 dollars .
My little boy was in the hospital for a week with pneumonia in Sept and the
final bill was about 1500 dollars inclusive of medicatons and a private room .
An ultrasound cost about 20 bucks , an imaging machine ( to look for a kidney stone ) cost about 100 bucks , lab work for my blood and urine cost 6 dollars and i think the emergency room visit is 20 dollars . A hospital room is about 50 dollars / night ( cable and air conditioner. ) I have the telephone numbers of my doctors .
There are a great many very good doctors in town , the hospitals collect a deposit upon admission . The protocol here is to show up and to take a number and to wait without an appointment , i've never waited longer than an hour . I also think medication is less here also. Tramadol that i keep for kidney stones cost about 75 cents . It wouldn't make sense or be practical to move to another country for these reasons ( I did not get into dental care , but same deal , its a bargain and top notch . I just wanted to share this as i find it a big advantage in living overseas. Not to mention that my US based Health Insurance cost a lot less , 2500 bucks / year with an unlimited life time maximum and no out of pocket expense after i've spent a total of 13,500 for any one year . Thats all thanks
14
It is interesting The NY Times has not given commenters one chance to comment about Tom Price, the next Trump health guru. No comment section in articles covering our new Health and Human Service lead. You might as well leave Service out of the title.
You think things are bad now, folks, wait til he and his crowd, including Paul Ryan put you through the wringer.
Not enough that Dr. Price earned on the average $421,000/yr as an orthopedic surgeon, he'll put the screws to the common American's health benefit, and thus the common American. And it won't be orthopedic screws either. It'll be dollar $$$ screws. Get ready.
You think things are bad now, folks, wait til he and his crowd, including Paul Ryan put you through the wringer.
Not enough that Dr. Price earned on the average $421,000/yr as an orthopedic surgeon, he'll put the screws to the common American's health benefit, and thus the common American. And it won't be orthopedic screws either. It'll be dollar $$$ screws. Get ready.
24
and they love this guy too down in suburban Atlanta
6
I know a doctor making 300k per year on 4 days work week (net of all expenses, btw) who kvetchs about being underpaid. I know a very midlevel insurance executive making over 250k who kvetchs about being underpaid. I take a long-ago developed prescription drug that has gone up in price 200% in 4 years.
Get the picture?
Get the picture?
31
The American people should demand the same health care plan that members get. Not on iota less.
13
Isn't there already an itemized deduction for high out of pocket medical costs? People seem to not want to pay anything for healthcare. in essence. Medicaid. Be careful what you ask for because healthcare at that level can be far from satisfactory.
1
Yes - but only when it exceeds (I believe) 7% of your gross adjusted income.
5
Obamacare was flawed from its inception. To require a person who needs subsidies to cover the monthly premium, to pay a $10,000 deductible is risible at best. There was no talk of tort reform to enable medical and prescription costs to be lowered. To allow insurance companies to have a blank check from the government was also a big and negligent mistake. In the end, as always, it ended up being an experiment in socialized medicine with millions of taxpayers paying up for the subsidies.
4
I would advocate strongly on focusing on the expense to both insurers and patients of brand name drugs, both prescription and infusable. If citizens of the US had the same cost for drugs as other nations ( Canada, Belgium, England, and Israel for example) our insurance premiums and out of pocket costs would be lower. For many years, I purchased chemotherapy as a daily part of my job. The difference in cost between us in US and other nations was 40%. So a cancer regimen for a single drug might be $100,000, essentially overspending $40,000 for a single drug on a single patient. Just looking at Medicare spending on Oncology drugs alone, we are wasting tens of billions of dollars each year alone. Despite the highly paid talking points of drug companies and their major influence in Congress and DOJ, the country simply can't afford this situation anymore. Let Medicare and insurance companies negotiate drug prices.
13
Medicare and insurance companies negotiate drug prices with a single exception. Medicare A prices are negotiated by hospitals (but you couldn't tell by the prices hospitals charge to consumers). Medicare part C and D are negotiated by the insurers. The exception is drugs administered in a doctor's office and paid for by Medicare part B for non hospital services. It is difficult to negotiate a price for drugs purchased in small volumes, and it's not as if you could negotiate a standard price for chemotherapy. A peculiar aspect is that in addition to the high cost, Medicare pays 20% to the physician as a fee for administering the drug, so providers have a disincentive to negotiate lower prices.
You were apparently a buyer for the drugs. Why didn't you negotiate lower prices? The reason you didn't is the same reason the government doesn't. In in any negotiation, the alternative to a negotiated price is no sale. If a physician makes a professional judgement that a particular chemo drug is most appropriate for a particular patient, there is no bargaining power on the patients side except to the extent that there is another chemo drug available at a lower price. What happens in the countries you cite is not negotiation, it is price control by the government. A government bureaucrat decides on a "fair price" and the drug company either takes the price or it doesn't sell the drug in that country.
You were apparently a buyer for the drugs. Why didn't you negotiate lower prices? The reason you didn't is the same reason the government doesn't. In in any negotiation, the alternative to a negotiated price is no sale. If a physician makes a professional judgement that a particular chemo drug is most appropriate for a particular patient, there is no bargaining power on the patients side except to the extent that there is another chemo drug available at a lower price. What happens in the countries you cite is not negotiation, it is price control by the government. A government bureaucrat decides on a "fair price" and the drug company either takes the price or it doesn't sell the drug in that country.
1
The Medicare modernization act of 2003 explicitly prevents Medicare from negotiating drug prices for any reason and in every circumstance. All insurance companies and Medicare reimburse based on the cost of the drug that pharmaceutical companies set. In other countries, the drug companies are willing to make deals as you say. They are not losing money on these deals. Why shouldn't we do that here? In addition, Medicare does not pay a 20% fee to providers based on the drug cost. There is a group of chemo administration codes that cover the infusion uses services for their labor and supplies. That fee is set and not a percentage. The formula Medicare uses to reimburse drugs is ASP(average sales price) plus 4%. Part of that goes to middleman ( wholesalers). I did negotiate drug prices with the wholesalers, but the wiggle room is puny compared to the overall expense of the drugs, which is the main issue I am focusing on. Drug costs are simply too expensive to maintain and bringing them in line with the rest of the world really should reduce costs to insurance companies by quite a bit.
7
The problem is right now you have extremes. You have millions of illegals and other uninsured who continue to use Emergency Rooms, because of mandatory laws that require ER's to treat and hospitals to deliver babies for those in active labor.
Then you have zero co-pay for those in Medicaid, so they continue to misuse the ER. They show up with several children in tow for colds. They should have at least a $50-100 Cash ER payment. Urgent cares need to be incentivized to locate next door to the ER. ( I live closer to 3 hospital ER's then any urgent cares. I live 2.4 miles from the closet hospital. That does not make sense)
Then people want to be able to choose plans with higher premiums and lower deductibles, and more doctor and hospital choice. $250/500 deductibles are what people consider reasonable after paying a premium.
They don't want a plan with foreign educated doctors that they can't understand. That is in a major city. That is not choice.
Those that want a high deductible plan, should be required to set up a Medical Savings plan to cover the deductible. So the rest of us do not get stuck bailing them out when they get in that accident or they get sick.
Then you have zero co-pay for those in Medicaid, so they continue to misuse the ER. They show up with several children in tow for colds. They should have at least a $50-100 Cash ER payment. Urgent cares need to be incentivized to locate next door to the ER. ( I live closer to 3 hospital ER's then any urgent cares. I live 2.4 miles from the closet hospital. That does not make sense)
Then people want to be able to choose plans with higher premiums and lower deductibles, and more doctor and hospital choice. $250/500 deductibles are what people consider reasonable after paying a premium.
They don't want a plan with foreign educated doctors that they can't understand. That is in a major city. That is not choice.
Those that want a high deductible plan, should be required to set up a Medical Savings plan to cover the deductible. So the rest of us do not get stuck bailing them out when they get in that accident or they get sick.
2
"They don't want a doctor they can't understand."
Even if he/she is the most brilliant one in town?
Well, they can have white, good old boy, all American Southern Tom Price then.
From your home state, MJS.
Even if he/she is the most brilliant one in town?
Well, they can have white, good old boy, all American Southern Tom Price then.
From your home state, MJS.
9
In a land as financially and technology blessed as ours there can be no logical reason for our healthcare system to be this convoluted, expensive, wasteful and unavailable. The very rich that pay Senators to write our laws and tax codes want to those making less than six figures dead. Ideally, sooner rather than later, at the least cost to themselves. You death is to come slowly, painfully after spending your entire life savings and childrens' inheritance on drugs, surgeries and therapies that only delay the inevitable. When people in power (the same folks who pollute our air and water for profit) become a direct THREAT to the health of a nation, they are ENEMIES OF THE PEOPLE, and should be identified, shamed and punished. The people have every right to defend themselves from this aggression. If you believe healthcare is a RIGHT, then we should rise up, as our ancestors did 240 years ago, to demand single payer national healthcare - with NO options for states to opt in or out - and a nationalization of the Big Pharma and Big Insurance companies who hold us hostage to their monopoly controls. When terminally ill patients and grieving parents take the law into their own hands and exact revenge on the suits, perhaps then our government will listen and implement Medicare for all in an effort to protect the very wealth that remain.
20
To Steve the Tuna:
The rich that paid Congress to write the laws governing health care costs are the big medicine cronies who love the increase in revenue that has flowed to them from ObamaCare. And they paid the Democrats in Congress, not the Republicans, since not one Republican voted for ObamaCare. Although the Democrats talk a good story, they wrote the law and the regulations to shovel extra money to the drug companies, the big hospital chains and the insurance companies. Small medical practices are far worse off under the law, as are rural and inner city hospitals that serve the poor.
The solution to rising cost of providing quality medical services is not a one size fits all federal solution. If the government were to impose Medicaid for all, you can guarantee that the drug companies will increase their profitability, as will the large hospital chains and the insurance companies that will shed their risk in the market but will stay on to administer the single payer nirvana you recommend.
The rich that paid Congress to write the laws governing health care costs are the big medicine cronies who love the increase in revenue that has flowed to them from ObamaCare. And they paid the Democrats in Congress, not the Republicans, since not one Republican voted for ObamaCare. Although the Democrats talk a good story, they wrote the law and the regulations to shovel extra money to the drug companies, the big hospital chains and the insurance companies. Small medical practices are far worse off under the law, as are rural and inner city hospitals that serve the poor.
The solution to rising cost of providing quality medical services is not a one size fits all federal solution. If the government were to impose Medicaid for all, you can guarantee that the drug companies will increase their profitability, as will the large hospital chains and the insurance companies that will shed their risk in the market but will stay on to administer the single payer nirvana you recommend.
1
Why not copy what they have in Canada and just let Mr. Trump say he thought of it first?
18
It is so touching that you think the Trump administration is actually going to care about policy, balancing and trade-offs. Wherever did you get this idea?
15
Another big issue this article does not cover is the lack of out-of-network coverage. I have a platinum policy but all of my doctors are out-of-network so the only thing my policy is paying for is meds. My pre-ACA policy had out-of-network coverage for half the price but had to be terminated because it did not provide maternity benefits. So much for being able to keep your doctors and your old policy if you like it.
8
It never ceases to amaze me that our American neighbours are constantly debating an issue that every other industrialized country has solved long ago. Health care is not a business but a right.
39
to A Proud Canadian:
Your words are disturbingly sane!
Here in the land ruled by The Money God, health care IS a business!
If it doesn't make an outlandish profit for someone who is already wealthy, then... what's the point?
Healthcare for those who can't afford it?
Not here, my friend... not here.
Your words are disturbingly sane!
Here in the land ruled by The Money God, health care IS a business!
If it doesn't make an outlandish profit for someone who is already wealthy, then... what's the point?
Healthcare for those who can't afford it?
Not here, my friend... not here.
11
Alaska appears to have the right model. The state is paying for the most expensive people and this brings premiums down for everyone else.
5
Meantime I live in Europe, where I enjoy socialized medicine, and have one less thing to worry about. Oh, but wait, that is socialism, such a bad word.
30
and when good medical care is needed they come to the US... ever wonder why?
Because they can AFFORD to do so, that's why.
That's not true. Europeans not only have cheaper medical care; they have care at least as good as the best care we have. And as a result they have a longer life expectancy than we do.
8
I would be very grateful for more information from the Upshot on one of the aspects of health insurance under the ACA. I note that both Medicare and private health insurers negotiate with health providers for significant discounts from the providers' private individual market prices. (I presume Medicaid does the same.) Are those discounts an additional benefit to those who obtain coverage through the ACA? Or do the insurance companies themselves get the sole benefit of those discounts, leaving the patient to pay deductibles and co-pays based on the private individual market prices? If the former, then the Upshot analysis is underestimating how much an individual loses by doing without insurance (either through the ACA or not).
1
To David K Leonard: You get the benefit of the insurers negotiated prices if you are in network. Sometimes you have no coverage out of network, but I am going to assume that your policy has a $2k deductible followed by 20% coinsurance for in-network with a $6k out-of-pocket maximum, $4k deductible followed by 40% coinsurance with a $12k out-of-pocket maximum for out-of-network.
You get sick and go to the hospital. The hospital sends you and your insurer an itemized bill for $30k at list cost. Your insurer compares each line item and says the negotiated amount is $15k, and your cost is $2k for your deductible plus $2.6k (20% of the remaining $13k). The insurer pays $10.4k.
You get $5k bills each for the surgeon and the anesthetist. Fortunately for you, they are both in network. For each, the insurer says the negotiated price is $2 k, the insurer pays $1.6k for each, and you owe your coinsurance payment of $400 to each.
You get a bill for $5k from the emergency room physician, who is out-of-network. The insurer goes to an industry standard database and makes the determination that the “reasonable” charge is $3,500. You haven’t met your $4,000 oon deductible, so you have to pay the $3500, which goes toward meeting your oon deductible and you also have to pay the other $1,500, which does not eat into your deductible or apply to your oop maximum.
You get sick and go to the hospital. The hospital sends you and your insurer an itemized bill for $30k at list cost. Your insurer compares each line item and says the negotiated amount is $15k, and your cost is $2k for your deductible plus $2.6k (20% of the remaining $13k). The insurer pays $10.4k.
You get $5k bills each for the surgeon and the anesthetist. Fortunately for you, they are both in network. For each, the insurer says the negotiated price is $2 k, the insurer pays $1.6k for each, and you owe your coinsurance payment of $400 to each.
You get a bill for $5k from the emergency room physician, who is out-of-network. The insurer goes to an industry standard database and makes the determination that the “reasonable” charge is $3,500. You haven’t met your $4,000 oon deductible, so you have to pay the $3500, which goes toward meeting your oon deductible and you also have to pay the other $1,500, which does not eat into your deductible or apply to your oop maximum.
The phrase "skin in the game" is hugely offensive. What does it mean? Do you think cancer patients don't have "skin in the game?" In reality the idea means imposing huge financial burdens on people who are ill. It should be permanently retired from use.
29
Thank you. I'm an educated consumer with a PhD (not in a medical field) and when my daughter was diagnosed with cancer a year ago there was zero way that she or I could reduce her medical expenses without forgoing care or treatment that her doctors felt was critical. Her (excellent) in network care was through an HMO; there was no way she could bargain the prices. Besides that, she needed immediate care; negotiating prices was the last thing she or we had time for. This idea that we can lower prices individually is nonsense. It's the kind of nonsense that we can expect from a bunch of really dumb--and very rich--people who never have to consider that for themselves.
9
Mrs. Clinton's plan to reduce out-of pocket health care costs would have added $90 billion to the deficit per year but it would have been offset by tax increases for the very wealthy.
While Mr. Trump has no plan to reduce health care costs for consumers, his tax plan, which mostly benefits the very wealthy, would add at least $500 billion to the deficit each year and that is a conservative estimate.
Even more worrisome is the repeal of the ACA which will make health care unaffordable for millions of Americans and the voucherization of Medicare which will increase out-of-pocket costs for seniors. Tom Price, who will head Health and Human Services has promised to privatize Medicare 6-8 months after Trump is sworn in as president.
Fantastic tax cuts that will greatly increase the wealth of people like Mr. Trump who already possess the wealth to afford the best health care in the world and a tax cut of about 1.2% for a middle class household making $50,000 and much less affordable health care costs or no health care at all are a few of the ways Mr. Trump will "make America great again."
Those angry voters who supported Mr. Trump will get nothing but despair and desperation from his economic policies, as will most Americans.
500
While Mr. Trump has no plan to reduce health care costs for consumers, his tax plan, which mostly benefits the very wealthy, would add at least $500 billion to the deficit each year and that is a conservative estimate.
Even more worrisome is the repeal of the ACA which will make health care unaffordable for millions of Americans and the voucherization of Medicare which will increase out-of-pocket costs for seniors. Tom Price, who will head Health and Human Services has promised to privatize Medicare 6-8 months after Trump is sworn in as president.
Fantastic tax cuts that will greatly increase the wealth of people like Mr. Trump who already possess the wealth to afford the best health care in the world and a tax cut of about 1.2% for a middle class household making $50,000 and much less affordable health care costs or no health care at all are a few of the ways Mr. Trump will "make America great again."
Those angry voters who supported Mr. Trump will get nothing but despair and desperation from his economic policies, as will most Americans.
500
31
Our medical system is driven by the drug industry. They pay for studies which define limits for physical responses and provide drugs to keep us within those limits. The drugs themselves often have dangerous side effects. A new paradigm must be developed to treat to the patient rather than to statistically based tests aimed at drug intervention.
7
Winston Churchill once said, "You can always trust the Americans to do the right thing, after they have done all the wrong things first". He could well have been talking about US health care. Eventually we will realize that health care is not a conventional market as, for example buying a new TV, shopping for clothes etc.
1. The need for health care is nearly always unpredictable and when the need arises there is no opportunity to "shop around" for the best deal.
2. There is a profound information asymmetry between the provider and the patient. The latter is rarely in a position to challenge medical authority.
3. There is no real competition between providers of either care or insurance.
4. The outcomes of medical treatment always gave a degree of uncertainty.
5. There is no opportunity to "test drive" a procedure.
We need to see health care not as a market but as one of FDR's wants that should be considers a public good for a better society. As we regard clean air, clean water, education and security.
1. The need for health care is nearly always unpredictable and when the need arises there is no opportunity to "shop around" for the best deal.
2. There is a profound information asymmetry between the provider and the patient. The latter is rarely in a position to challenge medical authority.
3. There is no real competition between providers of either care or insurance.
4. The outcomes of medical treatment always gave a degree of uncertainty.
5. There is no opportunity to "test drive" a procedure.
We need to see health care not as a market but as one of FDR's wants that should be considers a public good for a better society. As we regard clean air, clean water, education and security.
33
What you say is very true, but will never happen. This is America you're talking about.
1
The only way health care can become a public good is if you force medical professionals to provide their services. It is immoral to enslave a portion of the population for the benefit of others in society. It does not make for a better society.
There is an article elsewhere in the NYT that questions whether the liberal democracies are reaching the point of instability. To the extent that the populist Democrats believe their will should be involuntarily imposed on the unwilling, democracy is doomed.
There is an article elsewhere in the NYT that questions whether the liberal democracies are reaching the point of instability. To the extent that the populist Democrats believe their will should be involuntarily imposed on the unwilling, democracy is doomed.
Healthcare should not be a profit center.
32
A more accurate description of actuarial value is: For example, a plan with an actuarial value of 70% (referred to as a "silver" plan in the ACA) means that for a standard population, the plan will pay 70% of their health care expenses, while the enrollees themselves will pay 30% through some combination of deductibles, copays, and coinsurance. See: https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8177.pdf
4
What no one has mentioned is that the luxury health insurance our lawmakers get should be taken away from them and they should have to deal with the same issues the rest of us deal with. Of course most of them are wealthy enough that it is likely to still be chump change to them rather than in my case more than 100% of my income (I live in a no medicaid expansion state, have a cancer with no cure, got fired for cancer and being "too expensive" for their insurance)... The only way I have kept myself is health care is a gofundme (and likely if I posted that this comment would not be approved - if the NYT's want to write an article about this kind of mess contact me) and that has donor fatigue. My premiums (silver plan) are going up to $1119/mo in 2017 with a combined $6000 deductible/out of pocket (which will be used fully). I guess that is one way to solve the poverty "problem" in this country - make health care out of reach. I have worked my entire life, payed in to the system my entire life, worked through chemo, and after being fired only have temp jobs as I can't find anything better (and not due to lack of trying). What has happened to me can happen to anyone. The financial toxicity of cancer (and other expensive medical problems) is real and means I will live out the rest of my life in poverty because all my savings, retirement money has had to go to medical care. They don't see you if you get far enough behind in your payments. No choice.
33
If you know you are going to meet your maxiumum out of pocket, why not go with a Bronze plan and save on the premiums?
1
The deductible is even higher for Bronze
7
What a waste of economic value.
We have all spent hours trying to figure out our best coverage.
Instead of innovating, working adding positive value, or even enjoying life and relaxing.
Spent any time fighting with your insurance company? Physician's office?
Worrying about ridiculous costs?
All economic value lost.
Copy one of Europe's healthcare systems or Japans and lets focus our efforts on building a stronger and more inclusive economy.
We have all spent hours trying to figure out our best coverage.
Instead of innovating, working adding positive value, or even enjoying life and relaxing.
Spent any time fighting with your insurance company? Physician's office?
Worrying about ridiculous costs?
All economic value lost.
Copy one of Europe's healthcare systems or Japans and lets focus our efforts on building a stronger and more inclusive economy.
40
I agree completely. The amount of human capital Americans spend navigating the healthcare system is tragic. We are all being held hostage by the privatization of one of our most fundamental needs.
8
With Trump's new Health Secretary it looks like a bleak future for individuals and a prosperous scenario for insurers is in the making.
23
"Be more responsible consumers of health care" is an appalling euphemism for don't seek care, accept care only from doctors who are willing to work for less than their peers, or settle for substandard procedures.
Here's one example: Medicare pays for monofocal intraocular lenses, which means the recipient is left with only distance vision. The irresponsible consumer can opt to pay for multifocal IOLs for an additional $3,000 to $4,000 each. Medicare argues that these have only a "cosmetic" benefit. I wonder how many falls, broken hips, and premature deaths result from being a partially blind responsible consumer.
Here's one example: Medicare pays for monofocal intraocular lenses, which means the recipient is left with only distance vision. The irresponsible consumer can opt to pay for multifocal IOLs for an additional $3,000 to $4,000 each. Medicare argues that these have only a "cosmetic" benefit. I wonder how many falls, broken hips, and premature deaths result from being a partially blind responsible consumer.
22
Whack the cost, not the use of needed care. An enormous reduction is possible. The Institute of Medicine, in a study published in 2012, reported that 30% of U.S. health care $s went for waste, inefficiency and the ineffective. The total cost? $900 billion/year; $9 trillion over a decade. Mega-$s for NO patient benefit and harms to health.
10
I'm a fully-licensed psychologist, not a physician, so do not know for sure that the following is true for medical doctors, but as we're covered under the same policies offered by the same companies, I have to assume there are parallels.
When I moved from university teaching to full-time practice (in Michigan) this past spring, I naively assumed that once paneled by the insurance companies, I would be able to work wherever I might choose: hospital, group practice, private practice, etc. What I've found is that this is not always, and maybe rarely the case as several in my practice have learned that though they are now paneled and able to receive insurance reimbursement for their services, the insurance companies determine whether or not they would maintain that privilege at another location with most saying that they would not because their, the insurance companies', calculations suggest that our specific community is "saturated" with providers and does not need any more. Disregarding the strange math that doesn't recognize the basic associative principles we all learned in elementary school, this is a clear instance in which the insurance companies are impacting not only how or for how long I can treat my clients, but literally if and where I can practice. And, arguably, it's an instance in which insurance companies are themselves minimizing the claimed benefits of choice and competition for clients by directly limiting the number of practitioners in a given area.
When I moved from university teaching to full-time practice (in Michigan) this past spring, I naively assumed that once paneled by the insurance companies, I would be able to work wherever I might choose: hospital, group practice, private practice, etc. What I've found is that this is not always, and maybe rarely the case as several in my practice have learned that though they are now paneled and able to receive insurance reimbursement for their services, the insurance companies determine whether or not they would maintain that privilege at another location with most saying that they would not because their, the insurance companies', calculations suggest that our specific community is "saturated" with providers and does not need any more. Disregarding the strange math that doesn't recognize the basic associative principles we all learned in elementary school, this is a clear instance in which the insurance companies are impacting not only how or for how long I can treat my clients, but literally if and where I can practice. And, arguably, it's an instance in which insurance companies are themselves minimizing the claimed benefits of choice and competition for clients by directly limiting the number of practitioners in a given area.
17
The first best way to cut healthcare spending is to stop healthcare-related advertising. No ads for pills and potions, hospitals, doctors, MRI or other imaging centers, cancer care pavilions, etc.. These offer no meaningful benefits to patients (now ridiculously renamed healthcare consumers), but obviously drive revenue generation which is distinctly different than actual healthcare. The second best way to decrease excessive, unnecessary spending is to increase the time patients spend with primary care physicians. Here's reality: if I'm expected to see 4 patients each hour, I simply do not have time to provide comprehensive care. Please realize that 15 minutes allotted to you must cover everything I might need to do for you - reviewing your history, the actual exam, documenting our encounter, prescribing medications, with time factored in for overhead obligations like arguing with your insurance company. Obviously, the only give in this system is the time I spend on your history and exam, so that's where corners get cut. I don't have 90 seconds to stop and thnk about your one complicating symptom or puzzle out a better medication regimen. I certainly don't have the time it would take to look anything up, so I either reschedule you for a follow-up, hoping to squeeze a little more time from our next encounter or I refer you to a costly specialist. It's ineffective and wasteful, but, hey, some kid with an MBA did a study "proving" you don't need the time.
27
The idea, that consumers need more "skin in the game" to be responsible users of healthcare, is completely ridiculous.
Americans are already extremely conservative users of healthcare and are more likely to forgo necessary or preventative care than our peer nations.
Out of pocket expenses need to be made smaller, not larger. Expand the risk pool to the entire nation. Cut bureaucracy and simplify billing administration. That alone would reduce costs by many tens of percent, and would not deny care to anyone.
Americans are already extremely conservative users of healthcare and are more likely to forgo necessary or preventative care than our peer nations.
Out of pocket expenses need to be made smaller, not larger. Expand the risk pool to the entire nation. Cut bureaucracy and simplify billing administration. That alone would reduce costs by many tens of percent, and would not deny care to anyone.
21
I completely disagree. People spend health care dollars like it is somebody else's money. It is amazing how costs come down when people are spending their own money. For example, notice how the cost of Lasik surgery has stayed about the same (it has not gone up much); Lasik is usually paid for by people themselves, not insurance.
1
RandyJ, how in the world are patients supposed to price shop health care procedures when they are unable to get accurate prices from hospitals or doctors? Lasik is one thing, cancer treatment something completely different. Even any surgery includes different bills from doctors, anesthesiologists, operating room, medications, etc.
4
I am okay with the idea of a single payer system as long as we understand it has a cost. For starters, we spend about 3.3-percent of our GDP on defense and most countries with single payer systems spend less than 2-percent. The cost of a single payer system is accepting a reduced role on the world stage, including in economic negotiations. A single payer system in the US probably means a change to our national identity and global order we have administered since WWII. This may be a better, happier future for us, but let's acknowledge nothing is free and major changes come with risk.
8
Single payer reduces total cost and shifts source of $s to pay for health care. No reduction in other govt. expenditures.
9
To say that the cost of medical care is the problem and not the insurance companies is missing the fact that the only reason care costs so much is because there are insurance companies working as the middle men. Without ins co's individuals would never be able to pay any of it. There needs to be an activist revolt against this absurd system. It will take widespread strikes and boycotts before anything ever changes. I think everyone who possibly can should stop going to the doctor and stop paying for insurance. I will join the fight right after my next checkup. Ha ha. They got us all!!!
20
Well, there could be a Healthcare March on Washington. Shut down the Capitol building until they either give us the healthcare policy that they enjoy or enact some form of single payer.
7
I commented earlier. Here are two real life examples from this year.
My 14 year old son was hit by a wave in the surf and dislocated his kneecap, requiring an operation under general anaesthetic, hi-tech leg braces, a three day stay in hospital, physiotherapy and so on. Cost? Zero.
I recently broke some cartilage off my knee (bad genes? :)) in the gym. I had an MRI ($17) and a visit with the best knee guy in the city ($28). OK, the costs were low because we had hit the ceiling for expenses this year - but none of us had been sick so the ceiling isn't high.
Other examples: Ambulances are free, even helicopters, which I had a few years ago. Emergency treatment is free.
There are some negatives: there are queues for elective surgery, sometimes quite long ones (maybe a year). Pharmaceuticals are usually about $10 to $15 per prescription. And so on.
We do pay for this. Me have a Medicare levy of (I think) 1.5% of our gross wages. And there is a surcharge of about the same amount for high income earners. And we do also pay for private medical insurance, just in case. But we rarely have to use it, and the majority of Australians don't have it.
You can do it in America, guys. If we did it, why can't you?
My 14 year old son was hit by a wave in the surf and dislocated his kneecap, requiring an operation under general anaesthetic, hi-tech leg braces, a three day stay in hospital, physiotherapy and so on. Cost? Zero.
I recently broke some cartilage off my knee (bad genes? :)) in the gym. I had an MRI ($17) and a visit with the best knee guy in the city ($28). OK, the costs were low because we had hit the ceiling for expenses this year - but none of us had been sick so the ceiling isn't high.
Other examples: Ambulances are free, even helicopters, which I had a few years ago. Emergency treatment is free.
There are some negatives: there are queues for elective surgery, sometimes quite long ones (maybe a year). Pharmaceuticals are usually about $10 to $15 per prescription. And so on.
We do pay for this. Me have a Medicare levy of (I think) 1.5% of our gross wages. And there is a surcharge of about the same amount for high income earners. And we do also pay for private medical insurance, just in case. But we rarely have to use it, and the majority of Australians don't have it.
You can do it in America, guys. If we did it, why can't you?
57
As an Australian had earlier pointed out, US has third world health insurance. Actually, in some ways it is EVEN worse - despite having vaunted advanced healthcare - because it SO MUCH MORE expensive. In third world countries one can get at least basic medical care - and in some cases even advanced care - for FAR LESS money.
Of course to citizens of EVERY advanced economy countries and others (such as Cuba) having FULL health-coverage, this article will sound gobbledygook.
And just like the reasons for not having gun control, reasons for NOT having FULL health-coverage will remain gobbledygook for EVER in US.
Of course to citizens of EVERY advanced economy countries and others (such as Cuba) having FULL health-coverage, this article will sound gobbledygook.
And just like the reasons for not having gun control, reasons for NOT having FULL health-coverage will remain gobbledygook for EVER in US.
22
For examples of less expensive treatment outside the US search on "Medicinal Tourism".
1
Any single payer healthcare plan would be so excessively expensive and would require enormous deductions to pay for it. Americans would be screaming. And they would have to pay for the 94 million people who are now out of the workforce. So much for "free healthcare."
2
That's the problem with universal care. No one is willing to pay for it. It was voted down in CO in November (funny how the NYT did not cover that) and also in VT due to the cost that the people of those states were not willing to pay for.
5
No. It would be far less expensive than the current system. The U.S. spends about 50% more on medical care than any other nation. Shifting to single payer would bring this spending down, because it would eliminate the 20% profit that's baked into the system. It's not going to happen any time soon, because the interests who profit from it are doing far too well. Insurers, big pharma, physician specialists, hospitals, big provider groups.
7
Some of my work colleagues are Canadian, are quite happy with their health care, and we discovered they pay about 3% more in income type taxes than I for this benefit (this did not include sales, gas or property taxes). That 3% does not seem excessive to me.
5
Members of Congress and the President should strive to give the American people a comparable insurance to what they have in terms of benefits, deductibles, caps, etc.
25
Something seems fundamentally unfair about all of these schemes.
4
Speaking as an Australian, you have third world healthcare. To imagine that someone's life depends on the depth of their wallet is abhorrent to me. For someone to be bankrupted by a visit to the ER - disgraceful.
This is not something that you can fix overnight. For a start you have to get big pharma not thinking that they are favored - and as they have the ear of the inner circle of government and politics you have a problem.
But guys, you have to just fix it. Every year the problem gets worse, not better. If you want to see how to do it, just visit almost any other country in the Western world to have a look at their system.
This is not something that you can fix overnight. For a start you have to get big pharma not thinking that they are favored - and as they have the ear of the inner circle of government and politics you have a problem.
But guys, you have to just fix it. Every year the problem gets worse, not better. If you want to see how to do it, just visit almost any other country in the Western world to have a look at their system.
56
Obamacare used five gimmicks to fund program that never added up. (1) Require healthy people to pay too much for healthcare. (2) Keep increasing taxes on the productive people. (3) Force providers to accept payments from ACA and Medicaid patients that don't cover costs. (4) Coerce insurance companies to take losses & charge less than their costs. (5) Mislead patients to have unsustainable out of pocket expenses. Now the people have spoken, and they want the gimmicks gone. Obamacare cannot be far behind.
11
I'm already on Medicare, and it was a great relief, because even with the most expensive supplement available locally, I'm saving $300 a month in premiums and not having to pay deductibles.
It happened just in time, too, because given the fact that the ACA specifically allows insurance companies to price-gouge people over 50, my premiums were edging into the range of being completely unaffordable. I had already had to drop insurance once before the ACA, because I couldn't afford both the premiums and the medical bills I needed to pay off--bills which were burdensome but did not meet my $5000 deductible.
Lowering the age of Medicare, perhaps by five years every year, would accomplish two things: 1) It would free the insurance companies from having to cover people they don't want to cover anyway, and 2) It would shore up Medicare's finances, because enrollees would pay premiums, like the 65+ crowd, but being younger, they would be have fewer ailments on average.
As currently constituted, the insurance companies are unnecessary, vulture-like middlemen who not only fail to add value but also reward employees for denying coverage. Even being non-profit, as those in Minnesota are, does not preclude a company from paying executives six or seven figures or holding "training sessions" in tropical resorts.
They are a drain on the economy and a prime cause of the U.S. spending more on health care than any other country.
It happened just in time, too, because given the fact that the ACA specifically allows insurance companies to price-gouge people over 50, my premiums were edging into the range of being completely unaffordable. I had already had to drop insurance once before the ACA, because I couldn't afford both the premiums and the medical bills I needed to pay off--bills which were burdensome but did not meet my $5000 deductible.
Lowering the age of Medicare, perhaps by five years every year, would accomplish two things: 1) It would free the insurance companies from having to cover people they don't want to cover anyway, and 2) It would shore up Medicare's finances, because enrollees would pay premiums, like the 65+ crowd, but being younger, they would be have fewer ailments on average.
As currently constituted, the insurance companies are unnecessary, vulture-like middlemen who not only fail to add value but also reward employees for denying coverage. Even being non-profit, as those in Minnesota are, does not preclude a company from paying executives six or seven figures or holding "training sessions" in tropical resorts.
They are a drain on the economy and a prime cause of the U.S. spending more on health care than any other country.
44
Everyone is already paying for Medicare and there is no cap. Adding people would require more money that would come from where.
The reason we spend more is we spend more on care at death, versus non heroic measures. That is a moral and ethical judgement, not an economical one.
The reason we spend more is we spend more on care at death, versus non heroic measures. That is a moral and ethical judgement, not an economical one.
1
Under the current system, only people 65 and older pay premiums. Bringing in younger premium payers would ease some of the financial burden. The Republicans' proposal to raise the age would only worsen the system's finances, since the new, older population would be even less healthy than the current population.
5
Brilliant idea. Lowering the age of medicare expands membership with the RIGHT kind of enrollee to improve the risk pool. Even if you made it optional to join medicare, who in their right mind would not? Medicare costs less than the ACA plans without subsidy and offer lower premiums and better benefits. What's not to like?
4
Corporations pay 11% of the federal revenue and in 1980 they paid about 30%. If we were to go back to those "good old days" and corporations lost all the tax dodges we would have more then enough revenue to pay for this plan of reducing costs and actually funding even more health care provisions. The money is there, it is being hidden by the corporation-political oligarchy.
If we were to raise payroll taxes 2-3% then a family making $60,000 a year would pay 1200 t0 1800 more but save over 6,000 in health payments. This would be through a public option . There are many ways to solve this problem but first the politicians must want to do this.
If we were to raise payroll taxes 2-3% then a family making $60,000 a year would pay 1200 t0 1800 more but save over 6,000 in health payments. This would be through a public option . There are many ways to solve this problem but first the politicians must want to do this.
19
Nice moniker.
Do you have any facts or evidence that the average family would save $3500+ a year? Or is it just a back of the envelope based on rich people having money?
Do you have any facts or evidence that the average family would save $3500+ a year? Or is it just a back of the envelope based on rich people having money?
1
"However, recent consumer data indicate that almost 50% of US consumers would have difficulty raising a "rainy day" fund of only $400. Unexpected and unplanned expenditures of $400 or more would be such a large expenditure to almost 50% of US consumers that such amounts would upend their household budget plans."
And yet, we spent $3 billion over the recent shopping weekend. Where does that $$ come from?
And yet, we spent $3 billion over the recent shopping weekend. Where does that $$ come from?
7
Credit card debt, primarily?
5
Credit card?
5
What do you mean by "we," O wealthy one?
My family's holiday spending spree is at zero thus far, since we have no money to spare.
My family's holiday spending spree is at zero thus far, since we have no money to spare.
11
Part of holding Drumpf and the GOP accountable is not only reporting on what they're trying to do, but confronting them in the media, perhaps on a weekly basis. Let's have reporters camped outside McConnell's and Ryans's offices, as well as Drumpf's and asking publicly. Reporters should feature a GOP community or state each week and show who voted for Repubs and what numbers of people are on Obamacare. Then get individual stories from those who will be the most affected. Oh, and keep asking for those details on the Repub "replacement" plan, please.
11
Medicare for all, and let the government negotiate with pharmaceutical companies like everyone else in the world.
54
Glad for the ACA. I now have insurance through work, but before the ACA I discovered that one of my pre-existing conditions was not MY condition, but having a first degree relative with a colon resection. He did not actually have a malignancy, but having the surgery qualified as a pre-existing condition for me.
Later, after an accident, when I had the pre-ACA "Pre-Existing Condition" government policy, I discovered that there were limitations on having two surgeries at the same time. I broke both my arms, and they would cover the second arm only at 50%. Many accident victims have more than one injury, I suspect. I appealed, and got a slightly better rate. Also the trauma surgeon on call was out of network and would sign no hospital contracts because he would not "get enough". It was all balance billed. The whole bill for 2 broken arms was in excess of $60,000.
Later, after an accident, when I had the pre-ACA "Pre-Existing Condition" government policy, I discovered that there were limitations on having two surgeries at the same time. I broke both my arms, and they would cover the second arm only at 50%. Many accident victims have more than one injury, I suspect. I appealed, and got a slightly better rate. Also the trauma surgeon on call was out of network and would sign no hospital contracts because he would not "get enough". It was all balance billed. The whole bill for 2 broken arms was in excess of $60,000.
21
Thank you for mentioning Chronic illness. Those with chronic illness spent 83% of the money ( Natl Institute of Medicine. This is not very many people. Most other people do not need help paying for their own care.Those with Chronic illness are the people who cannot afford the cheap plans with high deductibles and large co pays. They spend lots of money every month for the rest of their life. A government policy without discussing this is worthless.
16
When you stop looking at the graphic you do feel much better.
11
The way the actuarial value is explained here is misleading. It is not the percentage of an individual's cost of care covered by insurance. For instance, if you purchase a bronze plan, but only get the covered preventive services, your insurance will actually cover 100%, not 60%.
2
Thanks. Please do a similar article on automobile insurance.
4
Between my premiums and deductible, I have to spend $10k per year before the insurance company spends a dime.
I am actually OK with this set up; I have a nice cushion of savings and I am fortunately healthy (for now). Where I get aggravated is with the inability to determine actual costs ahead of time. We have been told that high deductible health plans reduce costs because consumers actually have to shop around. That's nice in theory, but it doesn't work.
Two examples: I want a skin cancer check from a dermatologist. I called one that accepts my insurance. They said the cost depends. Depends on what? If they remove something? No! It just "depends". OK, fine... I called the insurance company. The insurance company said an office visit for that doctor is $95, and I can use their online cost estimator in the future. Intrigued, I checked it out. The online cost for an office visit for this doctor is listed at $65. So how much will my cost actually be? Who knows?!
I would like a colonoscopy as I am nearing age 50. The cost is covered as "preventive", thank you, ACA. However, if they remove something during the procedure, it is no longer "preventive" and I will have an out of pocket cost. How much will that cost be? No one can tell me. I get a range on the insurance company's website, and from the example above, I know it's probably not correct. Sites that perform the procedure give me the same, "it depends".
It really shouldn't be this difficult!
I am actually OK with this set up; I have a nice cushion of savings and I am fortunately healthy (for now). Where I get aggravated is with the inability to determine actual costs ahead of time. We have been told that high deductible health plans reduce costs because consumers actually have to shop around. That's nice in theory, but it doesn't work.
Two examples: I want a skin cancer check from a dermatologist. I called one that accepts my insurance. They said the cost depends. Depends on what? If they remove something? No! It just "depends". OK, fine... I called the insurance company. The insurance company said an office visit for that doctor is $95, and I can use their online cost estimator in the future. Intrigued, I checked it out. The online cost for an office visit for this doctor is listed at $65. So how much will my cost actually be? Who knows?!
I would like a colonoscopy as I am nearing age 50. The cost is covered as "preventive", thank you, ACA. However, if they remove something during the procedure, it is no longer "preventive" and I will have an out of pocket cost. How much will that cost be? No one can tell me. I get a range on the insurance company's website, and from the example above, I know it's probably not correct. Sites that perform the procedure give me the same, "it depends".
It really shouldn't be this difficult!
57
Your comment is pretty much spot on. As a physician, I'm not allowed to bill by the hour or bill a pre-determined amount. Instead, there are multiple possible billing codes for a patient visit, and the exact level is determined by a byzantine set of rules designed to quantify the medical complexity of the visit. These certainly aren't my rules, but unfortunately I have no choice in the matter if I choose to accept insurance. It becomes even more complicated if an actual procedure is involved.
26
I have had the exact same experience in the US. But we had a problem in France and needed surgery. The prices were posted on the wall of the business office, just like in a café: 950 Euros per day all inclusive, except a couple of minor things, a few more Eruos.
10
One problem is the statistics gathering. There's a code for every part of a visit.
broken arm.
Between wrist and elbow?
Between elbow and shoulder?
A fall?
Engaged in an activity?
Skating?
Roller?
Ice?
Scooter?
Traffic accident?
Et cetera.
And so it goes.
broken arm.
Between wrist and elbow?
Between elbow and shoulder?
A fall?
Engaged in an activity?
Skating?
Roller?
Ice?
Scooter?
Traffic accident?
Et cetera.
And so it goes.
4
Insurance companies and hospitals totally own the game and the rules are worse than this. out of pocket max is for "covered care" - not your actual out of pocket but what they would"cover" if they were covering. So your exposure out of network can be pretty much unlimited. Also the unfairness of charging uninsured patients the maximum and then accepting less from insured patients is sickening. My lab work was about $1000 when insurance claim was mistakenly denied (??technique to delay so some people give up) Eventually was covered and about $150 was paid. So someone who got denied pays many multiples of negotiated rate . The whole pricing system is bizarre - look to veterinary medicine which has same tools and highly trained personnel but less overhead and administration - costs are way lower. (And they do lab work, MRI etc)
employer based insurance with better rates is also strange. Is a person who is self employed automatically less healthy? Insurance companies have gone wild with the system as it is and hospitals and senseless charge masters don't help. Obamacare gets a lot of blame nowadays but those same companies that cry over losses are raking in profits in overall scheme of things. Healthcare should not be something that can bankrupt you with one episode of appendicitis, and it's not just a business. If your arm is broken you don't ask ortho consult doc if they are in network.
The status quo players have too much money to lose to let things change.
employer based insurance with better rates is also strange. Is a person who is self employed automatically less healthy? Insurance companies have gone wild with the system as it is and hospitals and senseless charge masters don't help. Obamacare gets a lot of blame nowadays but those same companies that cry over losses are raking in profits in overall scheme of things. Healthcare should not be something that can bankrupt you with one episode of appendicitis, and it's not just a business. If your arm is broken you don't ask ortho consult doc if they are in network.
The status quo players have too much money to lose to let things change.
40
We can now kiss the ACA goodbye.
5
ALL for-profit health insurance leaves you dangerously uncovered. The insurance companies are free to deny you coverage at any time, on the grounds that your illness is not a "preferred" condition, the treatment you require is "experimental," or your surgeon is no longer "in-network." Read your policy. Everything is decided on a case-by-case basis, and there is no real guarantee of anything.
16
The animated graphic makes me want to vomit.
14
Another item to consider: when you change jobs during the year, you reset your deductible and need to pay again. I ended up in the emergency room in January and fulfilled my deductible. When my new job started later in the year, I had to start all over again with my deductible.
11
No one is going to fix healthcare, largely because it is too profitable as is for the major players.
The ONLY thing that fixes the problem of cost, which in turn fixes the problem of access to healthcare is cash. Medicine is a service, just like plumbing, just like electricians. If you were to pay cash for a doctor, you would pay anywhere from $20-$75 for a 15 minute visit. Some people could afford fellowship trained MDs, some could afford a physician assistant, some a nurse practitioner. All medications (HIV, cancer, diabetes) drop drastically. We make 10,000% profit on some meds that we dispense out of our clinic, and it’s awesome. We buy a medication for $5 and we charge “insurance” $470. It is essentially ben-gay. Try charging someone $470 for ben-gay when they’re paying cash, yet we do it all day long when some “3rd party” is paying the bill. Surgeries that we charge $50,000 in a hospital can be done for $2,500 and we would still make a profit. We have our own surgery center.
And finally, since health insurance no longer exists, unless you buy it personally for catastrophic instances, it will not be tax deductible or employer based. You pay it out of pocket if you choose. The $10,000 your employer pays per year for your family is in your pocket now, for 40 years. You have $400,000 to play with now. Stay healthy, don’t smoke, don’t get fat, don’t snowboard. And if you do, get ready to pay the orthopedist in cash at the time of your visit.
The ONLY thing that fixes the problem of cost, which in turn fixes the problem of access to healthcare is cash. Medicine is a service, just like plumbing, just like electricians. If you were to pay cash for a doctor, you would pay anywhere from $20-$75 for a 15 minute visit. Some people could afford fellowship trained MDs, some could afford a physician assistant, some a nurse practitioner. All medications (HIV, cancer, diabetes) drop drastically. We make 10,000% profit on some meds that we dispense out of our clinic, and it’s awesome. We buy a medication for $5 and we charge “insurance” $470. It is essentially ben-gay. Try charging someone $470 for ben-gay when they’re paying cash, yet we do it all day long when some “3rd party” is paying the bill. Surgeries that we charge $50,000 in a hospital can be done for $2,500 and we would still make a profit. We have our own surgery center.
And finally, since health insurance no longer exists, unless you buy it personally for catastrophic instances, it will not be tax deductible or employer based. You pay it out of pocket if you choose. The $10,000 your employer pays per year for your family is in your pocket now, for 40 years. You have $400,000 to play with now. Stay healthy, don’t smoke, don’t get fat, don’t snowboard. And if you do, get ready to pay the orthopedist in cash at the time of your visit.
8
Donald Driver - so those who get cancer (many cancers are not lifestyle preventable) i guess you get to die then if you have to pay anything over $10,000/year. I used up 1/3 of what you are listing as the life time limit of $400,000 in one year for chemo and medical care with cancer.
3
Regarding the mark up; it's astounding. I needed a CAT scan at the ER years ago when I had employer provided health care. I paid my $100 co-pay, but then received an "explanation of benefits" afterwards. For the pregnancy test, which was required before the CAT scan, the insurance company was charged $250 for an EPT pee stick that costs $8 at the pharmacy. I called the insurance company to complain and the representative said, "oh, we don't pay that much, and why do you care anyway? You're not paying for it". Indeed....
3
Comparison of my 2016/2017 options in Austin, TX for 44 yr old non smoking male
2016 silver plan (from some new, no name insurance co. that no doctors/pharmacies/therapists had ever heard of) -
$250/mo premium, $400 deductible, $2,250 out of pocket max
2017 bronze (no name insurance co.)
$279/mo, $6,150 deductible, $6,500 opm
2017 silver (from a somewhat recognizable insurance co.)
$369/mo, $3,000 deductible, $6,500 opm
2016 gold (no name insurance co.)
$295/mo, $0 deductible, $6,600 opm
2017 gold (no name insurance co.)
$400/mo, $0 deductible, $6,600 opm
2017 gold (from Blue Cross Blue Shield)
$622/mo, $500 deductible, $5,250 opm
2016 silver plan (from some new, no name insurance co. that no doctors/pharmacies/therapists had ever heard of) -
$250/mo premium, $400 deductible, $2,250 out of pocket max
2017 bronze (no name insurance co.)
$279/mo, $6,150 deductible, $6,500 opm
2017 silver (from a somewhat recognizable insurance co.)
$369/mo, $3,000 deductible, $6,500 opm
2016 gold (no name insurance co.)
$295/mo, $0 deductible, $6,600 opm
2017 gold (no name insurance co.)
$400/mo, $0 deductible, $6,600 opm
2017 gold (from Blue Cross Blue Shield)
$622/mo, $500 deductible, $5,250 opm
6
For an even more interesting comparison, go to the website for the Missouri Department of Health and Senior Services and price compare Medicare supplement plans. The premiums for the exact same coverage can vary by an enormous amount.
3
I guess I need t move to Austin. in 2017 I will be paying (silver) $1119/mo premium; $1000 deductible, $6000 out of pocket max. No combination of anything drops it below $900/mo. I don't smoke either. Am 63.
2
A laughable shill for the Indiana experiment opting out of the regular ACA program substituting it's own plan.
The 60/40 split under the insurance term-of-art, actuarial value, for we know as revenue is nice work if you can get it. Patients must still cover costs providers of care shell out to peel insurer's fingers off the 60% pay out.
The suggestion to ease coverage for the very ill is the usual velvet glove over the iron fist of the insurers. Indiana lost a federal case ruling Indiana must heed the Social Security Administration's ruling of disability and medically frail because Indiana's own officials were that unfair. They cannot be trusted.
Even so, there are other tricks, for instance, the algorithm used to determine how much those on medicaid must pay according to income and other factors like number in the family, etc. is a "black box". I entered the data for a year and noticed interesting patterns re: who was granted eligibility or not and how much they must pay. That was the state system under greater scrutiny than private insurance cloaked under the protection of the sacred "private enterprise".
Don't be fooled by Bread & Circus ruses like this. They only solidify protection of insurers who have yet to explain how and why coverage must go up still more when we're still the most expensive inferior care in the world taking 40% off the top.
Like I said, nice work if you can get it. And we didn't even get to deductibles yet . . .
The 60/40 split under the insurance term-of-art, actuarial value, for we know as revenue is nice work if you can get it. Patients must still cover costs providers of care shell out to peel insurer's fingers off the 60% pay out.
The suggestion to ease coverage for the very ill is the usual velvet glove over the iron fist of the insurers. Indiana lost a federal case ruling Indiana must heed the Social Security Administration's ruling of disability and medically frail because Indiana's own officials were that unfair. They cannot be trusted.
Even so, there are other tricks, for instance, the algorithm used to determine how much those on medicaid must pay according to income and other factors like number in the family, etc. is a "black box". I entered the data for a year and noticed interesting patterns re: who was granted eligibility or not and how much they must pay. That was the state system under greater scrutiny than private insurance cloaked under the protection of the sacred "private enterprise".
Don't be fooled by Bread & Circus ruses like this. They only solidify protection of insurers who have yet to explain how and why coverage must go up still more when we're still the most expensive inferior care in the world taking 40% off the top.
Like I said, nice work if you can get it. And we didn't even get to deductibles yet . . .
11
Like all healthcare decisions, cost/benefit calculations intrude into the health insurance purchase decision. Simply, the higher the deductible the insurance purchaser agrees to contract for, the cheaper the cost of this insurance plan. Also, in general, the higher the copay the insured consumer contracts for, the cheaper the cost of the insurance. The more limited or restricted the network of healthcare providers the insured consumer will accept, then the better the utilization of facilities' rates, and accordingly the cheaper the treatment per patient.
However, recent consumer data indicate that almost 50% of US consumers would have difficulty raising a "rainy day" fund of only $400. Unexpected and unplanned expenditures of $400 or more would be such a large expenditure to almost 50% of US consumers that such amounts would upend their household budget plans.
The deductibles mentioned in this analysis are so much larger in comparison to only $400, which is budget disruptive for so many consumers, that the "give and take" of the discussion seems to have become fantasy-based; perhaps the discussion is no longer anchored or tethered to real world data.
Also, does the digitization of medical records, by its very nature, which the ACA encouraged, lead to broader medical consults with expensive, out-of-network providers? These out-of-network fees amount to a very expensive, unforeseen copay for many of the insured.
[JJL M 11/28/2016 2:19p Greenville NC]
However, recent consumer data indicate that almost 50% of US consumers would have difficulty raising a "rainy day" fund of only $400. Unexpected and unplanned expenditures of $400 or more would be such a large expenditure to almost 50% of US consumers that such amounts would upend their household budget plans.
The deductibles mentioned in this analysis are so much larger in comparison to only $400, which is budget disruptive for so many consumers, that the "give and take" of the discussion seems to have become fantasy-based; perhaps the discussion is no longer anchored or tethered to real world data.
Also, does the digitization of medical records, by its very nature, which the ACA encouraged, lead to broader medical consults with expensive, out-of-network providers? These out-of-network fees amount to a very expensive, unforeseen copay for many of the insured.
[JJL M 11/28/2016 2:19p Greenville NC]
8
Thoughts:
Republicans do not have any interest in any form of heath insurance/health care that 1) involves the federal government and 2) does not promise profit for private industry.
That America has seen that the free market over the last 70 years has not been a success in terms of either insurance or health care cost control is immaterial.
Universal health care in America? Not in my lifetime (I'm 72...).
Republicans do not have any interest in any form of heath insurance/health care that 1) involves the federal government and 2) does not promise profit for private industry.
That America has seen that the free market over the last 70 years has not been a success in terms of either insurance or health care cost control is immaterial.
Universal health care in America? Not in my lifetime (I'm 72...).
23
Health Insurance companies have harmed American Families more than terrorism, Zika Viruses, or Hillary Clinton's server.
Simply stated: Health Insurance Companies have increased their prices beyond the range of financial sanity.
Thank goodness politicians will dance and go to bed with Insurance Companies, because if left to the free market, Americans would stop paying for their ridiculous premiums, and Health Insurance companies would simply go out of business.
Simply stated: Health Insurance Companies have increased their prices beyond the range of financial sanity.
Thank goodness politicians will dance and go to bed with Insurance Companies, because if left to the free market, Americans would stop paying for their ridiculous premiums, and Health Insurance companies would simply go out of business.
31
Actually, it is obama and his so called "affordable care act" that is harming families. The law requires for the coverage of pre-existing conditions, which means insurance companies do not have a choice. Maybe what we need to get rid of are ridiculous politicians and their ridculous policies, e.g., obama and sHrillary? November 8th was just a start.
Clearly, euthanizing the sick and disabled is the free market creative destruction solution that cuts health care costs in the US. Starting with lots more abortions for the poor who are more likely to produce disabled and unhealthy kids and adults.
12
I am a small businessperson who must buy my own insurance. I do not qualify for any subsidy. I have no major chronic illnesses and i'm not a heavy consumer of healthcare services.
Prior to Obamacare, the healthcare insurance system for people who have to buy their own was a disaster. On the alleged "free market" (rigged against customers) I was locked into a policy with escalating premiums and nowhere to go. The pre-ACA policy I had did not really fit my current needs, but I could not even consider changing because the pre-existing clauses would preclude future treatment of the things I'd most likely need to be treated for in the future.
It's nice when you're 20 and have not had many injuries and illnesses to say, let's go back to the old way. But the reason the Obama admin has gone through all this torture to make the ACA happen was that the system was broken and a total rip-off.
In the 1990s, the Clintons promised healthcare reform--it died. Subsequent presidents have done nothing--W's "reforms" benefitted the drug companies but not the rest of us.
We have waited a long long time for healthcare reform, as the "free market" system has become more and more predatory. With all it's imperfections, we won't give ACA up without a big fight.
Prior to Obamacare, the healthcare insurance system for people who have to buy their own was a disaster. On the alleged "free market" (rigged against customers) I was locked into a policy with escalating premiums and nowhere to go. The pre-ACA policy I had did not really fit my current needs, but I could not even consider changing because the pre-existing clauses would preclude future treatment of the things I'd most likely need to be treated for in the future.
It's nice when you're 20 and have not had many injuries and illnesses to say, let's go back to the old way. But the reason the Obama admin has gone through all this torture to make the ACA happen was that the system was broken and a total rip-off.
In the 1990s, the Clintons promised healthcare reform--it died. Subsequent presidents have done nothing--W's "reforms" benefitted the drug companies but not the rest of us.
We have waited a long long time for healthcare reform, as the "free market" system has become more and more predatory. With all it's imperfections, we won't give ACA up without a big fight.
27
Yet more evidence -- not that we needed it -- that we need Medicare for all.
25
I disagree from a fiscal standpoint. Unless people are paying for their care, they will over-consume healthcare and the costs will destroy our budget. The old saying is that in healthcare there is cost, quality, and access. And you only get to keep 2 out of the 3. If you have Medicare for all (full access) and you don't have infinitely deep pockets, quality will decrease. I think the first thing that happens is rationing. In many State sponsored systems which many of you want to emulate, patients wait for their surgeries, and some would be organ recipients are never supplied with an organ because of cost. Americans don't want to have a bureaucrat do a calculation to decide whether they get treated this year or next. Plus the bets and the brightest definitely get driven out of medicine and into Wall Street when this happens. Everyone is salaried, and everyone goes home at 4:oo with their lunch pail. It would ruin the profession.
2
Medicare requires patients to pay a lot for their care, 20% of all doctors and hospitals bills and 100% of drug costs by high drug insurance premiums and high drug co-pays.
Plus Medicare pays doctors and hospitals much less than insurers or patients.
Yes, you can buy private insurance to pay part of educate co-pays, but that comes out of your pocket along with the Part B premiums which is means tested and costs upper middle class people 85% of doctor bill insurance costs.
Plus Medicare pays doctors and hospitals much less than insurers or patients.
Yes, you can buy private insurance to pay part of educate co-pays, but that comes out of your pocket along with the Part B premiums which is means tested and costs upper middle class people 85% of doctor bill insurance costs.
4
As long as everyone has contributed all their lives to medicare, no problem. Otherwise call it for what it is, welfare.
1
Before Obamacare was rolled out, I attended a Rand Corp. briefing on it in Washington. During the Q&A, I asked a couple of questions, including whether "price controls are off the table" (which I had inferred from the Rand economists' commentary). When by chance I had C-SPAN on the tube when it aired the briefing, to my amazement I heard my voice--and that part about price controls being off the table had been deftly edited out. Who asked for that edit, I wonder.
17
Insurance is not the Answer for American Health Care. Profits over people will leave us wined, dined, and blind.
14
Under the ACA, this year I'm paying $165/month for insurance with a $6,500 deductible. That's with the tax credit. That's the lowest-cost bronze plan available.
Next year, my credit will go up $30. The price of the lowest-cost plan, with the credit, will be $290, with the same $6,500 deductible.
It's nice to know that if I get hit by a car or get cancer, I will have insurance to help pay for treatment.
But on a day to day basis, I can't afford to visit a doctor. It's a good thing that at age 57, I'm pretty healthy. I haven't seen a doctor since 2009, when I had an abscess in my jaw. I used a walk-in clinic then. The money I would use for that, is now going to the ACA insurance.
Next year, my credit will go up $30. The price of the lowest-cost plan, with the credit, will be $290, with the same $6,500 deductible.
It's nice to know that if I get hit by a car or get cancer, I will have insurance to help pay for treatment.
But on a day to day basis, I can't afford to visit a doctor. It's a good thing that at age 57, I'm pretty healthy. I haven't seen a doctor since 2009, when I had an abscess in my jaw. I used a walk-in clinic then. The money I would use for that, is now going to the ACA insurance.
11
The only thing that could make the ACA work under any circumstance is having healthy people pay into the scam, and never have to need medical care.
5
Check all of the plans. The silver plans are often better than the bronze in terms of out of pocket costs. Otherwise, look for an even higher deductible/lower premium plan. If you aren't going to go to the doctor anyway, then all you need is a catastrophic plan that will keep you from going bankrupt if you get really sick. I know ACA is far, far from perfect, but if you had any experience with paying for private insurance before ACA, you would be happy not to continue to spend 25% of your income on premiums, deductibles, and co-pays. Even with ACA we spend about 10-15% of our income on healthcare, but it's still a far sight better than 25%. And please, go to a clinic and get a basic physical. Some of the very common meds for things like blood pressure can be had for $4/month at pharmacies, and you don't really need to worry about getting your healthcare plan involved.
7
I have to go with the lowest cost plan. That is all I can afford. Frankly, I'm not sure I can afford the $290/month next year--and that's the cost after the credit is applied. There are no lower cost/higher deductible plans. This is as cheap as it gets in my state.
Two years ago, I qualified for the free Medicare plan. But then I made $6000 more the following year. At which point, my insurance costs $1980/year, and the deductible is $6,500. You will note that deductible is more than the increase in my wages, before taxes.
I work two jobs, one full-time but only 10 months a year, one part-time. At neither do I qualify for benefits.
This insurance will save me from going bankrupt if I get really sick or have a very bad accident. But, say, if I get pneumonia? a strep throat? a really bad sinus infection? I can't afford time off from work, and I can't afford to go to the doctor. Most of the people I work with can't, either.
Two years ago, I qualified for the free Medicare plan. But then I made $6000 more the following year. At which point, my insurance costs $1980/year, and the deductible is $6,500. You will note that deductible is more than the increase in my wages, before taxes.
I work two jobs, one full-time but only 10 months a year, one part-time. At neither do I qualify for benefits.
This insurance will save me from going bankrupt if I get really sick or have a very bad accident. But, say, if I get pneumonia? a strep throat? a really bad sinus infection? I can't afford time off from work, and I can't afford to go to the doctor. Most of the people I work with can't, either.
6
I have over 30 years experience in the health care industry. There are a number of combinations of benefits, premium payments and tax credits to allow insurance policies to reduce the current high-deductible amounts. The real challenge is getting of all the stakeholders involved to meet and negotiate an approach that works for everyone. Its not clear to us in the industry if that opportunity will be realized, until the new administration suggest next steps.
2
The author notes, "one of the most favored means by which conservatives proposed to bring down health care spending was to have consumers put more “skin in the game.” Many of them believed that if consumers were more exposed to health care spending, if they had to pay more out of pocket for care, then they would be more responsible consumers because of it."
I actually agree with this premise as PART of the overall solution to the healthcare problem in the U.S., except for one fact: health care providers don't have rate sheets for consumers. Go ahead, call your primary care physician and ask what the cost of a well-care visit will be. Most likely the answer will be, "We don't know."
As someone who is self-employed and who has chosen not to participate in ACA due to the cost (approx 20% of my income, including the deductible for a bronze plan in Connecticut), I can give you qualitative stories from the consumer front lines. I have called many providers to get rate sheets. It is rare to find a provider who will give you a cost estimate up front. Even when you acknowledge that you understand that, based on the visit, the doctor may decide to conduct other services while you are there, it is rare to get a quote or even an estimate. Getting quotes from hospitals is even more difficult.
I actually agree with this premise as PART of the overall solution to the healthcare problem in the U.S., except for one fact: health care providers don't have rate sheets for consumers. Go ahead, call your primary care physician and ask what the cost of a well-care visit will be. Most likely the answer will be, "We don't know."
As someone who is self-employed and who has chosen not to participate in ACA due to the cost (approx 20% of my income, including the deductible for a bronze plan in Connecticut), I can give you qualitative stories from the consumer front lines. I have called many providers to get rate sheets. It is rare to find a provider who will give you a cost estimate up front. Even when you acknowledge that you understand that, based on the visit, the doctor may decide to conduct other services while you are there, it is rare to get a quote or even an estimate. Getting quotes from hospitals is even more difficult.
17
I've tried repeatedly over the years to get quotes. Have gotten quotes and prices a few times but not once, not once!, have they been correct!
One doctor reacted to my question about costs by bringing in a form for me to sign acknowledging that I understood I was personally responsible for any costs not covered by insurance. I was never told what those costs were or what they might be but I was expected to assume responsibility for them without knowing. Might as well hand them a signed blank check. No other business does that!
One doctor reacted to my question about costs by bringing in a form for me to sign acknowledging that I understood I was personally responsible for any costs not covered by insurance. I was never told what those costs were or what they might be but I was expected to assume responsibility for them without knowing. Might as well hand them a signed blank check. No other business does that!
41
@Susan: "..chosen not to participate in ACA.." Does that mean you are paying the penalty? If you are, I'm curious to know how muchg that penalty costs compared with how much it would cost to get an ACA policy?
6
Andy, that is part of the problem; the penalty is significantly lower than any premiums. I think it's less than $1,000 a year. I have a cheapie bronze plan and $1,000 is 3 months worth of premiums.
The number one problem here is the incredibly high cost of healthcare in the US.
Progressive policy-makers constantly talk about the need for better insurance, but better insurance would just flood more $ to hospitals, administrators, drug companies, etc. etc. etc. The only way to make healthcare more affordable (and in the process keep Medicare from eventually breaking the bank) is to somehow limit/eliminate cost increases in healthcare and roll the price of some things back. Should doctors and other well-trained medical personnel be highly compensated? I say yes, but you've got to draw a line somewhere.
I personally know a few MD specialists who live like large lottery winners. They are extremely wealthy. Yes, they got there through their own diligence and sweat through quite a few years of paltry earnings first, but now they are wealthier than anyone else I know. When I see a Lamborghini on the road, I think "There goes an anesthesiologist or neurosurgeon"
We're going to get to the point where healthcare costs will simply start sucking too much 'economic oxygen' out of the room to have a viable economy.
Progressive policy-makers constantly talk about the need for better insurance, but better insurance would just flood more $ to hospitals, administrators, drug companies, etc. etc. etc. The only way to make healthcare more affordable (and in the process keep Medicare from eventually breaking the bank) is to somehow limit/eliminate cost increases in healthcare and roll the price of some things back. Should doctors and other well-trained medical personnel be highly compensated? I say yes, but you've got to draw a line somewhere.
I personally know a few MD specialists who live like large lottery winners. They are extremely wealthy. Yes, they got there through their own diligence and sweat through quite a few years of paltry earnings first, but now they are wealthier than anyone else I know. When I see a Lamborghini on the road, I think "There goes an anesthesiologist or neurosurgeon"
We're going to get to the point where healthcare costs will simply start sucking too much 'economic oxygen' out of the room to have a viable economy.
21
A minor but pertinent point: Just because the MD specialists are living like large lottery winners, it DOES NOT mean they are wealthy. They may well be living beyond their means. A fault of many physicians, I think.
3
Haven't we had enough of this kind of nonsense. No one in his/her right mind should think that tinkering with co-pays, deductibles or premium subsidies will solve the huge problems which lead to extra costs to consumers. The problem lies with the beast itself; that is, the insurance industry and the products it sells. These are designed to extract as much of our money as possible for the insurers and their client providers.. Since their greed, and their rules, govern the system, the only way to solve these problem is to kill the beast. That is, get rid of private health insurance and go to a single-payer system. The sooner, the better, I say.
89
Health insurance insures against the consequences of both your bad luck and your bad habits. As long as we don't make some effort to distinguish payments between the 2, health coverage will always be unaffordable.
7
" ... the consequences of both your bad luck and your bad habits. As long as we don't make some effort to distinguish payments between the 2, ... "
Distinguish between them?
You are aware that many people who never smoked the first time die from lung cancer every year and people who never took a drink die from liver disease (my dad was one of them)? Exactly how will you distinguish between them?
And exactly which bad habits would be included?
People who drive recklessly cause catastrophic injuries to others as well as themselves. Will they be included? How about people, mostly men, who frequently commit violent acts? I think these bad habits should certainly be on the list.
What about people who overeat? How about people who don't follow the most recent dietary guidelines?
How about people who never exercise?
How about people who fail to follow doctor's orders regarding taking medicine? What about people who can't afford to buy their medicines?
Tell us which habits you mean, how we determine who engaged in them, and exactly what the penalty should be.
Distinguish between them?
You are aware that many people who never smoked the first time die from lung cancer every year and people who never took a drink die from liver disease (my dad was one of them)? Exactly how will you distinguish between them?
And exactly which bad habits would be included?
People who drive recklessly cause catastrophic injuries to others as well as themselves. Will they be included? How about people, mostly men, who frequently commit violent acts? I think these bad habits should certainly be on the list.
What about people who overeat? How about people who don't follow the most recent dietary guidelines?
How about people who never exercise?
How about people who fail to follow doctor's orders regarding taking medicine? What about people who can't afford to buy their medicines?
Tell us which habits you mean, how we determine who engaged in them, and exactly what the penalty should be.
22
And I'm guessing that getting old will be put in the "bad habits" category? You would not believe how hard Blue Cross tried to get rid of me when I hit my mid-40s. It was illegal under HIPAA, but they nevertheless tried some underhanded schemes to dump me. We all have bad habits, and ACA has higher premiums for some of them, but you simply can't go down a list and decide who has led a more perfect life and deserves decent coverage and who doesn't. It's older people who cost the most in terms of health insurance, and I imagine I'll be one of them in another ten years or so, and my health care probably will cost a fortune if there isn't some reform of the whole healthcare industry. What "bad habit" are you going to use to keep someone from having knee replacement? Excessive jogging?
10
America is fast turning into a nation without a conscience -towards its own people.
The (unintended) consequences of pampering big business hoping they will invest,create jobs and look after their employees are exactly the opposite-sackings,tax evasion,fraud,profiteering at the expense of the weak and unprotected.
The (unintended) consequences of pampering big business hoping they will invest,create jobs and look after their employees are exactly the opposite-sackings,tax evasion,fraud,profiteering at the expense of the weak and unprotected.
45
I have to point out that Clinton's out-of-pocket tax credit had to be really really dug out of her site, as it's listed three levels down from her Web page:
https://www.hillaryclinton.com/issues/health-care/
https://www.hillaryclinton.com/briefing/factsheets/2016/07/09/hillary-cl...
https://www.hillaryclinton.com/briefing/factsheets/2015/09/23/clinton-pl...
Perhaps, the reason for this is the fact that Clinton planned to pay for the credit "by demanding rebates from drug manufacturers and asking the most fortunate to pay their fair share", and, as usual, since the math didn't really add up, the caveats were in calling the plan "progressive, targeted" (which means that many a middle class might not qualify for it), and the expenses to be "qualified" (which again may mean that it won't cover quite a few things).
In any case, since Hillary Clinton didn't advertise the plan broadly during her campaign, it doesn't look like she had either the 110 billions to pay for it in 2018, or the votes to pass a meaningful spending for the plan to be broad.
https://www.hillaryclinton.com/issues/health-care/
https://www.hillaryclinton.com/briefing/factsheets/2016/07/09/hillary-cl...
https://www.hillaryclinton.com/briefing/factsheets/2015/09/23/clinton-pl...
Perhaps, the reason for this is the fact that Clinton planned to pay for the credit "by demanding rebates from drug manufacturers and asking the most fortunate to pay their fair share", and, as usual, since the math didn't really add up, the caveats were in calling the plan "progressive, targeted" (which means that many a middle class might not qualify for it), and the expenses to be "qualified" (which again may mean that it won't cover quite a few things).
In any case, since Hillary Clinton didn't advertise the plan broadly during her campaign, it doesn't look like she had either the 110 billions to pay for it in 2018, or the votes to pass a meaningful spending for the plan to be broad.
6
It's a well established fact for most Americans that having or holding a health insurance card does not ensure access to quality affordable healthcare.
pnhp.org
pnhp.org
28
I'm considering forgoing insurance this coming year. I'd rather take care of myself and pay the fine for doing so.
5
So, La Seiche, will you have thousands of dollars to pay your way should you get cancer, or some other catastrophic illness? What happens if you get into a serious car (or other) accident? Thousands of more dollars to pay. Who do you think will pick up the tab for that (hint: your fellow taxpayers).
9
La Deiche - I got cancer and have close to $200,000 in health care costs in one year (fortunately the only costs now related to that 5 years later are annual checkups that run around $13,000 - this is a cancer with no cure so I sort of don't have a choice if I want to catch it early when it recurs). Exactly how would you plan to pay for that? Many medical centers stop seeing you if you miss payments for 3 months, some require thousands and thousands up front before they will treat you if you don't have health insurance. The ER doesn't give chemo. Unfortunately your choice would have to be wait it out until the following calendar year and hope you don't die of cancer before then or that it turns into stage 4 by delaying treatment.
6
Another aspect of health care that makes it a poor fit for capitalism and more resistant to change is that the consumer cannot opt out.
If I don't want to deal with, say, supermarkets, I can grow some of my food, buy from farmers markets, and order non-perishables and items with long shelf life online. If I don't want to deal with gyms or health clubs, I can buy my own exercise equipment for home along with videos. If I don't want to pay for cable, I can use satellite, just an antenna, download videos, etc.
No similar way of opting out of health care exists. If you have something as simple as a cut that needs a stitch, you must go to a local provider, who's very likely part of a large corporation. Drive to the next city and it may still be the same corporation running things. You're stuck and they know it.
If I don't want to deal with, say, supermarkets, I can grow some of my food, buy from farmers markets, and order non-perishables and items with long shelf life online. If I don't want to deal with gyms or health clubs, I can buy my own exercise equipment for home along with videos. If I don't want to pay for cable, I can use satellite, just an antenna, download videos, etc.
No similar way of opting out of health care exists. If you have something as simple as a cut that needs a stitch, you must go to a local provider, who's very likely part of a large corporation. Drive to the next city and it may still be the same corporation running things. You're stuck and they know it.
18
I wish she had indicated that cost sharing can be very devastating. It may sound fine to expect 20% or more as a cost share instead of high deductibles. BUT 20% of even a simple ER visit would be more than many deductibles and 20% of a whole hospital bill would be horrendous! Many people are just not aware of the high costs they could incur.
This system is not working and needs reform- not obliteration.
This system is not working and needs reform- not obliteration.
15
It is only necessary to look at the runaway medical cost / benefit ratio in the US to understand why paying for it is so difficult. (Search commonwealthfund "US Spends More on Health Care Than Other High-Income Nations But Has Lower Life Expectancy, Worse Health" for an overview). Costs still rising. Not having a public health care system is theoretically supposed to improve the medical cost / benefit ratio, but that is not working. The first step is to admit that it is failing.
11
Bravo to Aaron Carroll for revealing the scam of American healthcare.
For most Americans, holding an insurance card does not guarantee access to quality affordable prevention, medical, surgical or palliative healthcare.
The current scam will continue as long as hundreds of millions of dollars pour into the pockets of our Federal Representatives and Senators from the Pharma, Insurance, Med Mal, Publishing, Hospital and EMR industries.
Time to put patients and their doctors first!
pnhp.org
For most Americans, holding an insurance card does not guarantee access to quality affordable prevention, medical, surgical or palliative healthcare.
The current scam will continue as long as hundreds of millions of dollars pour into the pockets of our Federal Representatives and Senators from the Pharma, Insurance, Med Mal, Publishing, Hospital and EMR industries.
Time to put patients and their doctors first!
pnhp.org
33
Medicare is the answer. Big pharma doesn't like that answer. Insurers and their ridiculously highly paid executives don't like it. Both of these constituencies contribute mightily to our elected officials. But facts are facts. Medicare does not have the overhead associated with advertising, marketing or fancy offices. It is run by hard working government employees and does a very good job. It would be doing an even better job if Congress allowed it to negotiate drug prices with the pharmaceutical companies. The problem here is not finding a system that works. It is getting out of the way of expanding the system that does work.
58
Medicare may be the answer, but it has high out of pocket costs too, unless you can afford one of the more expensive supplementary plans. For instance, even with a supplement, I am responsible for up to $6,800 per year in out of pocket expenses should I need major tests, certain medications, or extensive care and treatment. And since I can't afford a more expensive supplemental plan, I certainly can't afford that much in deductibles and co-pays. So, as I have for much of my life, I just stay away from doctors as much as possible. America needs to rethink the whole shabang.
13
Oh really?
Medicare A premiums if you have to by in - $450++
Medicare B premiums (not hospitalization -everything else) - $133+ in 2017
Medicare D (prescription) - $50-60 per month (for a plan that actually covers many drugs)
Medigap Plan to cover the Part A costs after deductible and Part B costs after deductible = $110 -150 for someone 65 (and goes up by age)
Premiums per year (buy into Part A if not worked enough) = $8568
Deductibles
Part A $1315+/-
Part B $183
Part D $400
Total deductibles =$1898
Total = $10,466 PER person with buy-in and $5066 if worked enough for a 0 premium for Part A
Without a Medigap, then copays
Part A = $350+/- -650+/- PER DAY in hospital
Part B = 20%
Copays are UNLIMITED
Part D = $5 - 25% of cost of drug
No dental - even if teeth rotting or broken
No vision - unless cataracts or glaucoma etc
Medicare A premiums if you have to by in - $450++
Medicare B premiums (not hospitalization -everything else) - $133+ in 2017
Medicare D (prescription) - $50-60 per month (for a plan that actually covers many drugs)
Medigap Plan to cover the Part A costs after deductible and Part B costs after deductible = $110 -150 for someone 65 (and goes up by age)
Premiums per year (buy into Part A if not worked enough) = $8568
Deductibles
Part A $1315+/-
Part B $183
Part D $400
Total deductibles =$1898
Total = $10,466 PER person with buy-in and $5066 if worked enough for a 0 premium for Part A
Without a Medigap, then copays
Part A = $350+/- -650+/- PER DAY in hospital
Part B = 20%
Copays are UNLIMITED
Part D = $5 - 25% of cost of drug
No dental - even if teeth rotting or broken
No vision - unless cataracts or glaucoma etc
11
Medicare needs to be on a sliding scale.
6
But the headline of this column is an apt tagline for America, isn't it? Having insurance doesn't mean insurance will automatically and efficiently and graciously pay for what it purports to cover. Over many years of employer-sponsored coverage, I've had pretty good insurance that has (mostly) paid efficiently and correctly, and I've had pretty bad insurance that has, through incompetence or worse, followed the precept of "deny first and ask questions later, because we're hoping you'll just give up after being on hold for 50 minutes about a $21 claim." The insurance industry is a business. It exists to make a profit, in any way that it can. If it can't do so in one way, it will do so in another.
45
Insurance DOES pay for everything it purports to cover. That is not the same as paying for everything. It is , after all, insurance not pre-paid health care.
2
@ lcr999 "Insurance DOES pay for everything it purports to cover" BUT -
- consumers never know how much anything will cost;
- we frequently don't know if something will be covered or denied; - for employer provided insurance, we have no choice at all in what will be covered and what our co-pays or deductibles will be;
- we have little if any choice among providers in our area (many health care networks are city/county wide now);
- and we have little if any control over whether our premiums, co-pays, and deductibles are affordable.
- consumers never know how much anything will cost;
- we frequently don't know if something will be covered or denied; - for employer provided insurance, we have no choice at all in what will be covered and what our co-pays or deductibles will be;
- we have little if any choice among providers in our area (many health care networks are city/county wide now);
- and we have little if any control over whether our premiums, co-pays, and deductibles are affordable.
11
Yes, I was astonished to discover that my shingles vaccine, something recommended for every senior who has ever had chicken pox (i.e. almost all of us), was not covered by my supplemental policy. It was billed at $335, and I had to pay all of it.
Now it's not a rare or experimental drug, and given the potential size of the eligible population, it must be mass produced, so what possible justification could there be for the $335 price tag?
Now it's not a rare or experimental drug, and given the potential size of the eligible population, it must be mass produced, so what possible justification could there be for the $335 price tag?
4
Until President-Elect Trump has an actual replacement plan for Obamacare, there is nothing to discuss about his plan.
Until any GOP member has an actual replacement plan for Obamacare, there is nothing to discuss about their plans. Some claim they have a plan. Let's see it, then.
So, far all we get are pieces of plans, none of which are workable for most Americans. This whole "skin in the game" charade is simply a word game for putting more costs onto the American people in order to provide the maximum profits to insurance companies and Wall Street. Any calls to privatize Medicare is simply a way for those in power to pull more cash out of the pockets of Americans to put into the pockets of the top 1%.
Until the huge profit motive is removed from the insurance business, there is no reason to expect any plans presented by any politician will be to the benefit of most Americans.
Until any GOP member has an actual replacement plan for Obamacare, there is nothing to discuss about their plans. Some claim they have a plan. Let's see it, then.
So, far all we get are pieces of plans, none of which are workable for most Americans. This whole "skin in the game" charade is simply a word game for putting more costs onto the American people in order to provide the maximum profits to insurance companies and Wall Street. Any calls to privatize Medicare is simply a way for those in power to pull more cash out of the pockets of Americans to put into the pockets of the top 1%.
Until the huge profit motive is removed from the insurance business, there is no reason to expect any plans presented by any politician will be to the benefit of most Americans.
79
The underlying problem is that US medical care is simply way too expensive. Until we wrestle with that central fact, we will not solve the problem by tinkering with plan design. Intelligent regulation, along the lines of how we handle other public utilities, is in order.
46
I don't know how you break the lobbying stranglehold of all the powerful vested interests in this value chain:
* For profit hospital and medical groups
* Medical supply and distribution companies
* Pharmaceutical and medical devices
* Insurance Companies
* Billing management companies (for healthcare providers)
* Insurance management companies (for employers)
All that cost you are talking about is their profit (and jobs) -- they are going to fight this to the (our) death.
* For profit hospital and medical groups
* Medical supply and distribution companies
* Pharmaceutical and medical devices
* Insurance Companies
* Billing management companies (for healthcare providers)
* Insurance management companies (for employers)
All that cost you are talking about is their profit (and jobs) -- they are going to fight this to the (our) death.
29
Must VOTE OUT the corrupt politicians in DC! We'll have another chance in two years people, if the country isn't bankrupt by then!
4
There is a very simple way to make healthcare affordable for everyone - it's called MEDICARE. And it works b/c it cuts out most of the middlemen, the profit-makers who are sucking money out of our pockets to enrich themselves.
We have come to believe healthcare is expensive - and sometimes it is - but a lot of the cost is really $$ going to pay huge salaries to private insurance company execs, and to maintain those for-profit companies' bureaucracies (which are devoted to denying or "losing" our claims much too often.)
We have come to believe healthcare is expensive - and sometimes it is - but a lot of the cost is really $$ going to pay huge salaries to private insurance company execs, and to maintain those for-profit companies' bureaucracies (which are devoted to denying or "losing" our claims much too often.)
67
See how many docs take Medicare before you promote the plan. The cost savings from Medicare is forcing docs, etc to take less revenue than the cost of providing services. And handing over medical bureaucracy to the slowest, highest paid bureaucracy will not reduce that overhead at all.
Now how long will that be a working plan?
Now how long will that be a working plan?
1
In Cuba doctors are paid $40/mth. and are arguably better than ours. So what to do. Draft them into a national health corp. and pay accordingly but no more than a good mechanic.
9
I'm sorry, but I'm not going through 7 years of intensive training, 60-80 hour weeks, and 200k in debt to make $40 a month. Good luck.
10
Thanks C. for more compelling reasons to destroy our dysfunctional medical system. Cheers!
3
I don't think Cuban doctors have debt from medical school, just saying.
3
Professor Carroll does not mention Paul Ryan's plan for replacing Obamacare - A "Better" Way.
Employers have been on a long, slow march to eliminated their responsibility for health benefit costs for all but those with catastrophic illnesses. They have been raising employees out-of-pocket (e.g., deductibles, co-insurance and co-payments) faster that the cost of coverage has been increasing.
Paul Ryan's plan would accelerate cost shifting to individuals by suddenly putting in place vouchers that will only cover plans with high deductibles and/or limited coverage.
Trump has not health coverage plan, but Paul Ryan does and he heads the House. That is the plan to watch out for.
Employers have been on a long, slow march to eliminated their responsibility for health benefit costs for all but those with catastrophic illnesses. They have been raising employees out-of-pocket (e.g., deductibles, co-insurance and co-payments) faster that the cost of coverage has been increasing.
Paul Ryan's plan would accelerate cost shifting to individuals by suddenly putting in place vouchers that will only cover plans with high deductibles and/or limited coverage.
Trump has not health coverage plan, but Paul Ryan does and he heads the House. That is the plan to watch out for.
21
The simple reason that Americans pay so much for healthcare - more than any other advanced nation - is because we end up subsidizing most other nations' healthcare. FACT: Healthcare corporations make most of their profits off the backs of American consumers. There are no pricing or cost controls, because the healthcare industry OWNS Congress.
Until we wake up and demand fair and reasonable pricing for American citizens we will continue to be fleeced.
Until we wake up and demand fair and reasonable pricing for American citizens we will continue to be fleeced.
47
No, health care costs in the US are not high because health care costs in Germany, France, Japan and every other developed country are low. Yes, drug costs in other countries are low, but that's only a fraction of all health care spending. We pay more, much more, for every thing not just drugs.
6
American consumers subsidize other countries healthcare. As taxpayers we end up paying for much of the R&D as well. Prior to ACA, almost 60% of the personal bankruptcies in this country were medical related. That's sad.
And WHY are many other advanced nations able to negotiate SO MUCH BETTER pricing for the same healthcare products and services? Why can I drive to Canada and get drugs at 50% cheaper prices than the same drugs here? And it's not just drugs, we are charged more for medical devices, supplies, and the hospital conglomerates use their power to offer little in the way of discounting to the insurance companies.
And WHY are many other advanced nations able to negotiate SO MUCH BETTER pricing for the same healthcare products and services? Why can I drive to Canada and get drugs at 50% cheaper prices than the same drugs here? And it's not just drugs, we are charged more for medical devices, supplies, and the hospital conglomerates use their power to offer little in the way of discounting to the insurance companies.
2
You forgot another cost associated with EVERYONE's healthcare coverage that people seem to forget about: balance-billed charges.
' Balance billing, sometimes also called extra billing, is the practice of a healthcare provider billing a patient for the difference between what the patient's health insurance chooses to reimburse and what the provider chooses to charge.'
These are charges NOT INCLUDED in your premiums, deductibles, OR total out-of-pocket which all of us will pay if you have some big healthcare expenses.
' Balance billing, sometimes also called extra billing, is the practice of a healthcare provider billing a patient for the difference between what the patient's health insurance chooses to reimburse and what the provider chooses to charge.'
These are charges NOT INCLUDED in your premiums, deductibles, OR total out-of-pocket which all of us will pay if you have some big healthcare expenses.
22
Are you sure this is not covered in the out-of-pocket max? My friend was just hit with a $4000 balance bill for the first of 6 chemo sessions. If this counts against her out-of-pocket-max, she might be able to scrape by. But $24,000 in uncovered bills will crush her. (There is also the pesky $1,500 out-of-network bill she got for a doctor who wandered through the room while my friend was being operated on.)
5
Those visits by out-of-network providers in the operating room and elsewhere should be illegal. The hospital, surgeon, etc. knows the insurance of the patient. My sister is fighting now about a bill from the surgical assistant who was supplied by a private company. She actually works at that hospital (HCA facility, btw) and has their insurance. What a racket. Should NOT be allowed. They, HCA, probably gets a kickback from the company that provides the surgical PA/NP. Disgusting practice.
16
Just FYI: balance billing is prohibited for Medicare. For physician fees, Medicare pays 80% of the agreed price (which Medicare sets). The patient or patient's supplemental insurance makes up the 20%. This is the agreement patients and providers endorse when they participate in Medicare. No surprises. Nor should there be.
7
How in the world is it OK for an insurance company to pay out just 60 cents of every dollar of health insurance premiums it takes in? What happens to the other 40 cents? Answer: it lines the pockets of top executives.
Professor Carroll fails to point out that Medicare pays out 95 cents of every dollar it takes in for actual medical care. Professor Carroll fails to point out that we pay nearly twice the percentage of our GDP on health care, while receiving outcomes that are far worse than those other countries.
And Professor Carroll fails to point out that "skin in the game" means that people who are sick, or suspect that they are sick, simply don't get the treatment they need. They suffer quietly until they can't ignore their affliction any longer.
Could we have Upshot commentators who are actually willing to call out the immoral health insurance industry that is plaguing this country?
Professor Carroll fails to point out that Medicare pays out 95 cents of every dollar it takes in for actual medical care. Professor Carroll fails to point out that we pay nearly twice the percentage of our GDP on health care, while receiving outcomes that are far worse than those other countries.
And Professor Carroll fails to point out that "skin in the game" means that people who are sick, or suspect that they are sick, simply don't get the treatment they need. They suffer quietly until they can't ignore their affliction any longer.
Could we have Upshot commentators who are actually willing to call out the immoral health insurance industry that is plaguing this country?
157
"How in the world is it OK for an insurance company to pay out just 60 cents of every dollar of health insurance premiums it takes in?"---source? you are confused.
2
You should watch Dr. Carroll's YouTube channel, he has made those points many times... And I believe he has made them in past columns as well, though don't quote me on that. @HCTriage
1
Sean in Greenwich,
I'm in the Amen corner
!
The alleged "free market" insurance companies behaved in a predatory manner for so long, I'm not sure they know how to give the consumer a fair deal for his/her money.
With ACA/Obamacare, I have a huge amount of skin in the game.
I am not a heavy consumer of healthcare services--but if I had a heart attack or car wreck, it could quickly take away my life's savings, and I do have insurance (of the ACA variety). I don't go to the doctor unless it's urgent.
I'm outraged that the GOPers think we need to have "more skin in the game."
I'm in the Amen corner
!
The alleged "free market" insurance companies behaved in a predatory manner for so long, I'm not sure they know how to give the consumer a fair deal for his/her money.
With ACA/Obamacare, I have a huge amount of skin in the game.
I am not a heavy consumer of healthcare services--but if I had a heart attack or car wreck, it could quickly take away my life's savings, and I do have insurance (of the ACA variety). I don't go to the doctor unless it's urgent.
I'm outraged that the GOPers think we need to have "more skin in the game."
6
I can't really say this better but here goes. Medical treatment feels like both a science and religion. Yet, it also is a business. And an art. Your body and mind may need medical care which can make you get better, feel better and sometimes save your life.
How to reconcile healthcare costs is way beyond my ability to even imagine what that would involve and how it would not impede getting the best healthcare you need.
How to reconcile healthcare costs is way beyond my ability to even imagine what that would involve and how it would not impede getting the best healthcare you need.
Here is the reality under the ACA - 2017 benchmark silver plan in this state with a $2000 deductible per person ($500 if under 250% Federal Poverty Level) & 30% copays up to the cap on costs.
I recently broke a wrist -had to be surgically repaired. The allowed bill amounts per the insurer-provider contracts came to $18790.
Waitress making $20000 per w/after tax income of $16914. ACA premiums/year = $996. Max out-of-pockets (deductible $500 +copays) = $3575.
Her cost for the broken wrist = $500 deductible + 30% = $5487. Hit the cap so total cost is $996 in premiums + $3575 = $4571,
That is 22.86% of gross income & 27% of take-home pay.
GO in uninsured as charity care = 0 to $1500.
Couple making $42000. Take-home pay = $34179. Premiums =$3595, max out-of-pockets = $14300.
Cost for wrist = premiums + deductible $4000 + 30% copays = $12032
28.65% of gross income & 35.2% of take-home pay.
If they hit the cap on out-of-pockets & premiums = 42.61% gross pay & 52.36% of take home.
Pretty much bankruptcy time for both the waitress & the couple if they need minimal medical care.
--
Clintons' tax credits are meaningless unless one has taxes due = to the amount of the credit.
__
Median worker makes $27600 (Soc Sec data). That's $13.27/hour
Only 35% of workers make $50,000 & up; only 13% make $75000 & up; & only 6% make $100,000 & up
94% of workers can not BEGIN to pay $400+ an hour for a surgeon or $800/hour for use of an outpatient surgery center.
-
I recently broke a wrist -had to be surgically repaired. The allowed bill amounts per the insurer-provider contracts came to $18790.
Waitress making $20000 per w/after tax income of $16914. ACA premiums/year = $996. Max out-of-pockets (deductible $500 +copays) = $3575.
Her cost for the broken wrist = $500 deductible + 30% = $5487. Hit the cap so total cost is $996 in premiums + $3575 = $4571,
That is 22.86% of gross income & 27% of take-home pay.
GO in uninsured as charity care = 0 to $1500.
Couple making $42000. Take-home pay = $34179. Premiums =$3595, max out-of-pockets = $14300.
Cost for wrist = premiums + deductible $4000 + 30% copays = $12032
28.65% of gross income & 35.2% of take-home pay.
If they hit the cap on out-of-pockets & premiums = 42.61% gross pay & 52.36% of take home.
Pretty much bankruptcy time for both the waitress & the couple if they need minimal medical care.
--
Clintons' tax credits are meaningless unless one has taxes due = to the amount of the credit.
__
Median worker makes $27600 (Soc Sec data). That's $13.27/hour
Only 35% of workers make $50,000 & up; only 13% make $75000 & up; & only 6% make $100,000 & up
94% of workers can not BEGIN to pay $400+ an hour for a surgeon or $800/hour for use of an outpatient surgery center.
-
127
I was uninsured when I broke my hip. A surgeon repaired it and although he reduced his fee, it was more than I could afford and I couldn't pay it. The doctor along with every medical group that gave me care, sent their charges to collections and sent my credit rating down the drain. I applied to the hospital to write off their charges but the charge off still had its effect. No health insurance meant no PT. My friend who I lived with wrangled two at home sessions with a PT who showed me what to do and I did my own PT. ACA helped because I got a tax break and was able to get treatment, yet I had a hard time paying my part. I am now on Medicare and pay $122 a month for it and pay $122 for supplemental and $26.50 for prescriptions. I pay quite a bit upfront but all medical expenses are paid.
14
Your examples would indeed be hardships and I agree with most of the other comments for this article in relation to our outrageous medical costs. However, having been a care giver for a cancer patient, I saw annual medical costs of greater than $500,000/year. In that situation, 6000 or even 12000/yr total cost for insurance, deductions, etc is nothing. For me, what makes the most sense is a single payer system, either an expanded Medicare program or something similar. Get rid of insurance group concept. Interesting side note - while under private insurance, one chemo treatment = $7000. After going onto Medicare, same treatment = $600. No complaints from the chemo facility.
14
If it's a tax credit, as opposed to a tax deduction, then they don't have to be paying taxes to receive it.
1
The solutions proposed here only suggest (require) people 'chip in' more money for the most expensive healthcare costs in the world...there is no mention of the exorbitant costs and the underlying reasons, (e.g. profit, paperwork, unnecessary procedures, etc.)...
23
Let's go over it again gang....to the few Republican and/or Trump supporters or other supporters of the republican plan reading this story.
Get a national health policy like Canada or a similar country.
The entire civilized world and not some civilized, like Rwanda, have national healthy plans covering all.
We are still living in the middle ages with our health system...
Get a national health policy like Canada or a similar country.
The entire civilized world and not some civilized, like Rwanda, have national healthy plans covering all.
We are still living in the middle ages with our health system...
106
What's healthcare like in Russia, as that may be our new role model?
1
We need to find ways to drive down the actual cost of healthcare. Shielding us from the cost has led to higher and higher prices. I recently had a short trip to my local hospital for a very minor surgery. I was amazed at the resort athsmophere
10
@Shiggy: No, we need to REMOVE the portion of "healthcare cost" that goes into the pockets of for-profit insurance companies. If the head of the insurance company is making millions a year, that $$ is coming from somewhere - and a lot of that has to do with denying claims, etc.
Also consider if you get an MRI from a privately-owned facility, the owners of that MRI are making a profit on your imaging.
So: what is the "actual" cost of healthcare, I ask you? Is it what it costs to provide the care, or is it what it costs to provide it AND make a nice profit for the insurer or facility owner?
BTW, you should consider yourself lucky if you haven't had to have surgery in a while!
PS: Would you have preferred being in a facility that was painted institutional green, with gray floors? The cost of paint is the same whether it's disgusting green or a cheerful color.
Also consider if you get an MRI from a privately-owned facility, the owners of that MRI are making a profit on your imaging.
So: what is the "actual" cost of healthcare, I ask you? Is it what it costs to provide the care, or is it what it costs to provide it AND make a nice profit for the insurer or facility owner?
BTW, you should consider yourself lucky if you haven't had to have surgery in a while!
PS: Would you have preferred being in a facility that was painted institutional green, with gray floors? The cost of paint is the same whether it's disgusting green or a cheerful color.
9
Insurance is not a particularly profitable business to be in. Actual health care is much more profitable. And insurance companies are the ONLY ones in the entire system that are capable and willing to negotiate prices down. Do you want the hospital to be able to charge you anything they want.?
We are insured through the workplace, and every year we see an increasing amount of cost sharing. It is now fairly substantial. We go to the doctors when we are sick, but the cost burden does keep us from seeking preventative care. Case in point, an abnormal mammogram. They want me to do a follow up in six months. Not going to happen, because it's not insured. Another example, is a spouse with celiacs. With a significantly higher incidence of disgestive cancers in celiacs, doctors recommend screening every five years. Not happening, because it's not covered.
16
Follow-up mammo required for your condition? I'd fight that one with the insurance company or get your doctor involved in getting approval, if you haven't done so already. Also, I know of NO insurance that doesn't cover colonoscopy--it's considered preventive and there's an official schedule from the CDC. Fighting these insurance companies is not easy, but it does happen. Good luck and good health.
5
Unfortunately, the insurance company does not recognize subsequent testing for an abnormal screening test (mammogram, colonoscopy) to be preventative care anymore. This means that if you could possibly go into a colonoscopy with no complaints expecting $0 out of pocket and come out of it with a large bill if there are abnormal findings. This may not be fair and I do not necessarily agree, but the insurance companies compensate this way. This is definitely a barrier to people seeking preventative care. I see it a lot.
7
The fundamental problem is the high cost of medical care. The discussion of insurance is how to pay for it, not how to reduce it. The more complexity added into the system makes it easier for providers to shield themselves from market pressure. As it is, many patients' medical costs are paid by insurance chosen by their employer. Add some government subsidies into the mix is not going to help.
In addition, the more the government subsidizes health insurance through ACA subsidies, tax credits to companies providing insurance, tax credits to individuals with high costs, the closer we come to health care largely paid for by taxpayers, but with none of the efficiency of a single payer system.
"Skin in the game" means the sick are supposed to put effective price pressure on providers where insurance companies and the government have failed. If insurance companies, with professional negotiators, and teams of actuaries can't do it, how can a patient who arrives sick at the emergency room?
In addition, the more the government subsidizes health insurance through ACA subsidies, tax credits to companies providing insurance, tax credits to individuals with high costs, the closer we come to health care largely paid for by taxpayers, but with none of the efficiency of a single payer system.
"Skin in the game" means the sick are supposed to put effective price pressure on providers where insurance companies and the government have failed. If insurance companies, with professional negotiators, and teams of actuaries can't do it, how can a patient who arrives sick at the emergency room?
78
Absolutely 100% correct. Why does this seem so hard for people to grasp? This is not an insurance problem. That's just a shell game moving costs around. The problem is that we pay more for medical care and drugs here than anywhere else in the world because we have no effective mechanism for price control and thinking that making individuals pay more out of pocket is going to create such a force is like thinking that throwing some grains of sand on the beach is going to hold back a tsunami.
72
Please explain Exactly what leverage would I get from paying a copay or deductible? I am the neediest person in the arrangement. I will have the same leverage (none) and be poorer while gaining not even a micron more pull for having spent a sizeable amount of my income doing it. I can't choose Dr. X or Dr. Y regardless of the quality or cost of their services because my network determines who I will see and how much they charge. I have zero influence. The skin in the game ploy is a bogus con thunk up by ALEC and politicians with many hands in their pockets. Get real.
6
@Nemo - That's why the system doesn't work. That's why doctors average $207K a year......well, maybe the system is working for some.
1
As long as we leave control in the hands of the private insurance industry we will continue to see more costs shifted to patients in order for the insurers to keep their premiums competitive.
What we need instead is a reduction in the profound administrative waste inherent in our dysfunctional financing system. Improving Medicare and providing it to everyone would recover about one-half of the trillion dollars we already spend on health care administration, freeing up enough funds to provide first dollar coverage to everyone under a pre-paid health care system.
It works in Canada and England, and since we spend much more on health care, it would certainly work here.
What we need instead is a reduction in the profound administrative waste inherent in our dysfunctional financing system. Improving Medicare and providing it to everyone would recover about one-half of the trillion dollars we already spend on health care administration, freeing up enough funds to provide first dollar coverage to everyone under a pre-paid health care system.
It works in Canada and England, and since we spend much more on health care, it would certainly work here.
59
We pay twice as much as all other civilized Countries while receiving substandard healthcare that still leaves about 29 million people uninsured. That is the only fact you need to know. Deductibles, copays, insurance networks, government subsidies, etc., are merely ways to prop up the predatory Medical Industrial Complex.
Our health and economic well-being are exploited by politicians who are bought and paid for by the MIC. It is disgraceful and immoral.
Single payer is the only answer.
Our health and economic well-being are exploited by politicians who are bought and paid for by the MIC. It is disgraceful and immoral.
Single payer is the only answer.
199
Bingo ScottW.....it is the nature of the beast denying reality.
We have this free enterprise obsession in this country re health care although it has gotten so bad we now have a de facto criminal system.
The rest of the civilized and not so civilized world are light yrs. ahead of us.
We have this free enterprise obsession in this country re health care although it has gotten so bad we now have a de facto criminal system.
The rest of the civilized and not so civilized world are light yrs. ahead of us.
18
The free market competition solves some problems really well, but not all problems. Who's is competing with who? Doctors with other doctors? Hospitals with other hospitals? And making an informed consumer choice is difficult given there is so little transparency into costs and outcomes. It is far easier to make an informed decision on buying a dishwasher than on picking a medical provider.
As we look around the world to find the best private sector, competition based approach to the health care crisis, it is telling that no country uses such an approach, for a reason. It doesn't work.
Tim
As we look around the world to find the best private sector, competition based approach to the health care crisis, it is telling that no country uses such an approach, for a reason. It doesn't work.
Tim
28
It is not a 'fact' that people here receive substandard health care. Nor do we pay twice as much as all other civilized countries; that is 'fact' without basis. Yes, there are people that are uninsured and many of those are uninsured because they don't want to pay for any health insurance, and others that make the decision that the just cannot afford insurance and eat, or have shelter.
The important fact is consumers (patients) have no say over costs whatsoever and they are at the mercy of hospitals, doctors, insurance companies. There is no competition on pricing. Guess why? The federal government established regulatory limits when Medicare/Medicaid came on the scene in the 1960's.
that eliminated consumer voice for service, when, how and cost. The federal government established a program where the only players are the insurance companies and health care providers. Consumers/patients are just incidental. The driver of costs is the intervention by the federal government, coupled with their lack of oversight on the program it instituted.
For those that are for single payer, they must not get "we are from the government, we are here to help", nor understand why health care is not affordable, driven by a bureaucracy whose sole purpose is to exist, and well.
The important fact is consumers (patients) have no say over costs whatsoever and they are at the mercy of hospitals, doctors, insurance companies. There is no competition on pricing. Guess why? The federal government established regulatory limits when Medicare/Medicaid came on the scene in the 1960's.
that eliminated consumer voice for service, when, how and cost. The federal government established a program where the only players are the insurance companies and health care providers. Consumers/patients are just incidental. The driver of costs is the intervention by the federal government, coupled with their lack of oversight on the program it instituted.
For those that are for single payer, they must not get "we are from the government, we are here to help", nor understand why health care is not affordable, driven by a bureaucracy whose sole purpose is to exist, and well.
1
Two problems I'd like to highlight.
First, most people don't know what warrants a visit to the doctor. Increasing out-of-pocket costs decreases visits for necessary visits and unnecessary ones at the same rate. For someone who is struggling financially, there often is no other choice but to put off medical concerns, often until it gets worse. I see this often as a family doctor in Harlem.
Second, administrative costs are out of control. Between the insurance company's costs and profit, and billing departments at doctors' offices and hospitals, overhead consumes nearly 30 cents of every healthcare dollar.
A Medicare-for-All single payer system would eliminate out-of-pocket costs and drastically reduce administrative costs. Everyone would be covered and would be able to afford to go to the doctor or emergency room when needed. It's not a radical idea, but it's the best move, financially and morally.
First, most people don't know what warrants a visit to the doctor. Increasing out-of-pocket costs decreases visits for necessary visits and unnecessary ones at the same rate. For someone who is struggling financially, there often is no other choice but to put off medical concerns, often until it gets worse. I see this often as a family doctor in Harlem.
Second, administrative costs are out of control. Between the insurance company's costs and profit, and billing departments at doctors' offices and hospitals, overhead consumes nearly 30 cents of every healthcare dollar.
A Medicare-for-All single payer system would eliminate out-of-pocket costs and drastically reduce administrative costs. Everyone would be covered and would be able to afford to go to the doctor or emergency room when needed. It's not a radical idea, but it's the best move, financially and morally.
183
Medicare covers 80% after you pay monthly premium for Part B (Dr coverage) leaving you to pay 20% of cost. You can purchase supplemental coverage, about $150 per month premium. So Medicare still costs out of pocket, and quite high.
If you want Medicare for all, where is the money going to come from? Already the Obama admin has taken $500 mil out of Medicare. There is no free lunsh.
If you want Medicare for all, where is the money going to come from? Already the Obama admin has taken $500 mil out of Medicare. There is no free lunsh.
2
I should have said "an Expanded and Improved Medicare for All", as is the title of H.R. 676, the single payer bill in the House of Representatives. You're right: the out-of-pocket costs of Medicare, as it stands now, is too high, and that should be improved!
As to where the money comes from, here are the basics: Currently, most of our healthcare costs are publicly financed (mostly Medicare, Medicaid and tax breaks for employer-based insurance). Then there are privately funded sources of healthcare spending, including premiums, deductibles, and copayments.
If we take all of the public healthcare funding, and we take all of the private money going into healthcare (converted into a fair, progressive tax), and we put both streams into a public health fund, we would have more than enough to cover every resident in this country with coverage so good there would be no out-of-pocket expenses (no deductibles, copayments or co-insurance). One might shudder at the though of increased taxes, but taxes would replace premiums that both businesses and individuals pay, and 95% of households would save money. This could only be done through a single-payer system, not a multi-payer mess like we have now, because a single payer system would save immensely on administrative costs.
(It would also save on the *psychological* administrative burden which would make my job so much better, but that's not what this article is about.)
As to where the money comes from, here are the basics: Currently, most of our healthcare costs are publicly financed (mostly Medicare, Medicaid and tax breaks for employer-based insurance). Then there are privately funded sources of healthcare spending, including premiums, deductibles, and copayments.
If we take all of the public healthcare funding, and we take all of the private money going into healthcare (converted into a fair, progressive tax), and we put both streams into a public health fund, we would have more than enough to cover every resident in this country with coverage so good there would be no out-of-pocket expenses (no deductibles, copayments or co-insurance). One might shudder at the though of increased taxes, but taxes would replace premiums that both businesses and individuals pay, and 95% of households would save money. This could only be done through a single-payer system, not a multi-payer mess like we have now, because a single payer system would save immensely on administrative costs.
(It would also save on the *psychological* administrative burden which would make my job so much better, but that's not what this article is about.)
6
Thus is a clear summary of how high deductibles and out of pocket spending overall affect use, and the difficulties in finding a solution. ( and that illustration, aside from making me dizzy, is how most explanations usually read).
4
We can take some lessons from other nations, but our population size, geographical spread and ethnic diversities create special problems. Prof. Carroll, and numerous others, are correct that issues surrounding personal spending burdens are not going away soon. A president with a hair-trigger tweet finger will not be much help.
Funding health care is a major problem for all modern developed nations. Republican penchants for cutting taxes for the well off and trimming funding for social safety nets would not bode well for universal health care access, particularly if "repeal and replace" took literal hold.
We cannot have a system where people can get whatever they want, whatever the cost: improved utilization review is critical. We cannot have an insurance system where the healthiest opt out of any collective responsibility--with the option to "sign up" the minute they get sick. We cannot have a system where young adults cannot afford decent basic care, with too-large deductibles or with their parents constantly shouldering their burden. Pharmaceutical firms cannot be allowed to charge what the market will bear and Medicare must be able to competitively bid for drugs. This is the short list.
Partisan state governments should (can they?) learn to work with the federal government to improve the system for all, with responsibilities levied on all sectors. Those governments should not have as a main goal the notion of obstructing attempts to improve national health coverage.
Funding health care is a major problem for all modern developed nations. Republican penchants for cutting taxes for the well off and trimming funding for social safety nets would not bode well for universal health care access, particularly if "repeal and replace" took literal hold.
We cannot have a system where people can get whatever they want, whatever the cost: improved utilization review is critical. We cannot have an insurance system where the healthiest opt out of any collective responsibility--with the option to "sign up" the minute they get sick. We cannot have a system where young adults cannot afford decent basic care, with too-large deductibles or with their parents constantly shouldering their burden. Pharmaceutical firms cannot be allowed to charge what the market will bear and Medicare must be able to competitively bid for drugs. This is the short list.
Partisan state governments should (can they?) learn to work with the federal government to improve the system for all, with responsibilities levied on all sectors. Those governments should not have as a main goal the notion of obstructing attempts to improve national health coverage.
25
As long as insurance companies are involved in healthcare profits will always come before people's health. The only policy we can afford has a deductible of over $6,000 per person. Preventative healthcare is a joke when a visit to my primary care physician has a co-pay of $80. Three unanticipated but unavoidable visits to walk-in clinics and the ER has cost us over $3000 in the span of 3 months. Premiums are going up and actual coverage is going down. Anxiety is one of the major factors contributing to ill health both mental and physical; anxiety about job security, about the environment, about the state of the nation, and of course the possibility of bankruptcy if one becomes seriously ill. Promised tax cuts will only exacerbate the problem, creating more anxiety for 99% of the nation. The system is beyond sick.
88
Please tell your story far and wide. People (and politicians) need to see "real-life" examples of how our healthcare system is so flawed that even with reform people are still really hurting. I'm not sure the government is even capable of putting a face on a policy these days, but it's worth the effort to try.
2
That family is not the only one. I have insurance - this is a no medicaid expansion state so I pay full price and live below the poverty line. I had to choose to be homeless to afford it. 19 months later I got into hud housing. I couldn't go without it because I have a cancer with no cure. My problem is I have sold just about everything of value i own and the premiums are going up to $1119/mo with $6000 total out of pocket/deductible. That is more than I make in a year (I work). I skip ALL medical visits for anything except cancer care. That mean I likely had pneumonia without medical care this last month. I haven't been to a dentist in 4 years. I haven't replaced my glasses lenses in 4 years and they need changed. I did have two emergency room visits due to a large cut that needed stitches and the urgent care center wouldn't do it (weekend). I also had a cat bite where my hand swelled to twice it's normal size in 7 hours and needed IV antibiotics. They wanted to admit me and i signed out against medical advice because I had no money to pay those expenses. Had I done that it would have meant no cancer care. Frankly I might as well live in a least developed nation for all I can't afford to get health care. It is uncertain if I will be able to keep my health care in 2017 past a few months so if my cancer comes back I guess I get to die. Welcome to American folks where we will solve our poverty problem by killing off the poor.
15
Before we look into tax credits, we need to eliminate the epidemic of healthcare fraud. Experts put medical billing errors at 60% - 80%, and it has been this way for decades. Healthcare providers count on bill complexity/confusion for profit.
Over half of insurer claim denials are overturned after the first appeal. The catch? You have to know how to appeal and be persistent to get the insurance company to honor your plan.
How can these abuses happen? Our government is asleep at the wheel. The "maximum annual out of pocket cost" is a farce, in large part because billing/claim fraud runs rampant in the industry. Until we see meaningful legislation to curb these systemic abuses, our fiscal health will continue to be in danger.
Over half of insurer claim denials are overturned after the first appeal. The catch? You have to know how to appeal and be persistent to get the insurance company to honor your plan.
How can these abuses happen? Our government is asleep at the wheel. The "maximum annual out of pocket cost" is a farce, in large part because billing/claim fraud runs rampant in the industry. Until we see meaningful legislation to curb these systemic abuses, our fiscal health will continue to be in danger.
23