60 years or so ago, insurance was mostly for hospitalizations or catastrophic reasons. Our family doctor had one nurse in his office and no other staff. My mom directly paid the Doc. We were working poor, but my family had no problem paying the bill because it was reasonable. Once insurance starting paying for routine or sick visits, a monster called bureaucracy took over everything. The health care system created lots of jobs to bill payments, process payments, monitor payments, negotiate 100s of different contracts which means prices vary, etc.
Also, I have witnessed the mindset change for people with insurance as most go to doctor for any minor reason which increases insurance premiums eventually. The mindset change also clogged doctor offices causing a shortage of doctors which created urgent care centers (more bureaucracy costs).
Quite frankly, it's a mess. Perhaps the only way to fix it is to return to the old ways which worked. Eliminate all insurance but for catastrophic.
As an aside, you are one of the few journalists remaining who tries to be unbiased. We desparately need folks like you.
A simple change suggestion. Charge a cash paying patient/customer the lowest price, not the ridiculous high charge that insurers reduces based on contracts.
Bravo Suzanne .Your experience was widely shared, even 15 years ago. Our building contractor, had catastrophic plan for his workers, and negotiated affordable visits with a local sole MD for his workers, based on a minimum number of visits.
The MD knew he had a base, the workers could afford a routine visit when needed, and they were covered for major needs, that rarely arrived, because most were mostly young and healthy.
FELLOW BALTIMORON HERE. THIS IS THE MOST BALTIMOREY SENTENCE: Of course, one could simply forego paying this extortionist fee for the peace of mind of hopefully not croaking from the financial stress of landing in the ER after an uninsured motorist T-bones you drag racing on the streets of Baltimore because the authorities don’t enforce traffic laws anymore.
I'm in a similar boat. Recently unemployed. We ponied up for COBRA which we knew was going to be expensive, but not DAMN THAT'S EXPENSIVE expensive.
U.S. health insurance policy was settled a decade earlier than you seem to think. It was during WWII when it was decided by the federal government that employer-provided insurance would be tax deductible for the business, but not for individuals (while in the duration of the war wages were also tightly controlled). The 50s were the height of union membership, and unions could negotiate for better benefits as well as wages, all on the assumption that near lifetime employment with one company would be the norm. But retirement benefits were not universal though, so Johnson's Great Society expanded SocSec with the creation of Medicare. At that time, healthcare costs across the economy were about 5% of GDP. Today it is around 17% of GDP. With PPACA, I lost great insurance because it was a dreaded "Cadillac plan" and to boot had to pay a greater share for less!
We have a crappy healthcare insurance market - no doubt. That is due to it not being at all like every other insurance market in the country, and that is because of first and foremost the tax policy going back to WWII and the idiot insistence on corporate (and government) paternalism.
Repealed before fully implemented - true. But employers act based on expectations, and in 2015 or 16, the expectation was it would be in effect. It was part of PPACA as passed, just like the infamous "penal-tax" for individual non-compliance. The fact that these provisions got piece-meal removal speaks to how ill-considered the whole venture was to begin with.
The penalty for not purchasing would have been paid by very few b/c it had to do with affordability as a percentage of income and you could make well over $100k per year and the premiums, even back then, weren't affordable, under THEIR definition.
The amount of the penalty is trivial compared to the principle of it. Kinda like the old line about if you've got nothing to hide, then why not allow the government to search whatever it wants?
You've captured the essence of the problem nicely. Our system evolved from the unintended consequences of a well-intentioned law, and now not only employs huge numbers of people but is also a major sector of the economy. As you say, it's complicated, and anyone promoting some sort of "magic bullet" simple solution is selling snake oil. That's true on both the left and the right.
The problem is I don't think any of the members of congress have the brains or the desire to forge real solutions. With a few exceptions, we could replace them with robots since they're only there to vote how their party tells them and to stick to the talking points.
Maybe it has always been that way and it's just more visible now due to social media. I don't know. But it doesn't look good.
A genuine mess. The exchange plans are 1) expensive (per month payment) plus 2) high deductible. The triple wammy of course is that the "insurance based costs" are oftentimes not cheaper than cash price, so you're paying a lot for a service (that accumulatives under your deductible, which is super high). Basically, plan on paying monthly + your deductible + co-insurance (up to the out of pocket max). For a family this will be $30,000, roughly? (Your contribution to the new medical facility and non-profit CEO compensation.)
Welcome to Obamacare. The legislation they fought so hard to pass and that he wanted his name attached for his legacy.
They really stuck it to the middle class and claimed is a great victory. Victory for who? Their donors?
There is one reason to actually sign for even a high deductible plan. Instead of being billed for the "list price" that almost nobody pays, you are billed at the much reduced insurance company rate. That's included in the plan because insurers don't want you to reach the deductible where they would have to start paying.
No insurance with the higher billing rate is a quick trip to bankruptcy.
I doubt this approach will do much and putting everyone on the very inefficient government plan isn't fiscally feasible. We need to blow the whole thing up, have people pay for basic care and have catastrophic insurance that prevents medical bankruptcy, removing the huge number of middlemen and administrative overhead that is swamping the system.
We need more competition. Obamacare was designed to create hospital monopolies and reduce competition from privately owned surgical centers.
Insurers exist to negotiate rates, not really to “insure”. With less competition there is no room on rates - most physician practices have been acquired by hospitals.
Almost all large employers self-insure. They hire the insurance companies only to create networks, negotiate rates, prevent fraud (which Medicare annd Medicaid are horrible at) and administer payments.
In an ideal world world the whole country would self insure, be able to seek treatment nationally at centers of excellence (rather than be forced to stay in state or in substandard networks by Obamacare) and we’d use insurers to negotiate rates and set up networks and weed out fraud.
Of course this is expensive. If your employer is paying $20k a year for insurance or you are paying $20k a year for Obamacare, the math says that your taxes are going to go up by $20k in a national self-insured program. There is no free lunch.
The only way to reduce costs is to increase competition and negotiate harder. This will mean more inconvenience and less choice (eg if the government says there are 1 million MRIs in a region annually and puts out a bid to contract for those at $500, chances are you won’t be going to your local hospital for the MRI- unless you want to make up the cost difference out of pocket.
A fundamental problem is that hospitals are hugely important local employers, the administrators s and staff are loyal voters, the nurses unions and the SEIU are huge political donors, etc.
They don’t want more competition, nor do the pols that get paid by those special interests. That’s why any state run system is always run for the benefit of the employees and unions, not the customers (see also, public schools and the NHS). I lived in Britain for many years and used the NHS. We don’t want that.
Hospital costs in the US are way out of line vs global norms and are the bulk of healthcare expenses. Pharma is only 15 percent.
The Repubs back Pharma generally and the Dems back hospitals. Doctors used to be Repub, but now that the majority of care is run by hospitals, that is changing.
We are never going to get more costs until we increase completion and we aren’t going to get that as long as the pols are paid by the hospitals.
And, with the advent of AI, people can take on more of their own care. I got an MRI and doctors wanted to do an expensive guided ultrasound for $7500 out of pocket. I asked AI to diagnose from it and learned i just needed PT, it gave me exercises and in a couple of months I was good as new. Doctors aren't trained to help people help themselves. There's no money in it.
I laugh when I hear "Medicare for all." We HAVE Medicare for all. Everyone who gets a paycheck gets Medicare payments deducted. Combined, the employer and employee pay nearly 3%. You pay that for you entire career, yet get no healthcare services. The good news is, when you turn 65, now it's all FREE! Ha ha, just kidding. No, you pay about $200/month until you die. Well, at least all your healthcare costs are covered. No, they aren't.
I turned 65 and went into Medicare just as Obamacare came into effect. Obama promised you could keep your doctor, and keep your insurance. He was lying his ass off. I didn't experience the pleasure of trying to find affordable care under the Affordable Care Act. But everyone I know, and I mean everyone, cursed the friggin exchanges, and the increased costs.
President Reagan famously said that the most terrifying nine words in the English language are, "We're from the government and we're here to help."
No, Virginia, there is no such thing as a benevolent government.
You pay $200+ for Medicare premium for 80% coverage. To cover the other 20% you get a supplement at $300+ a month. A prescription plan costs $50-$100/month with $2,000 deductible. Then pay out of pocket for dental, vision, and hearing. I'm paying the most I've ever paid my entire life for health care since I've been on Medicare.
Technically, your employers took salary away from you to give you health insurance. You were paying for it, one way or the other. And the taxpayer was subsidizing you, because that benefit (income in kind) was tax free yet your employer got to deduct that expense from their taxes.
Medicare is a fraction of the price of Obamacare, at least.
I’m happy to be on Medicare now after 10 years on Obamacare where I spent $275k on premiums for my wife and I. Then again, I see from my little government worksheet that my employer and I also paid $400k in Medicare taxes over my lifetime.
I’m just thankful/blessed that so far I’ve never had to run up a 7 figure medical expense to offset the 7 figures I've paid into the system between my share of employer coverage, Obamacare premiums and Medicare taxes over my lifetime.
My primary comment was in respect to what politicians are promising - 0 premium, 0 co-pays, everything including dental, vision and hearing for 'free,' which is an enormous lie.
I haven't kept close watch, but in the 14 years since I started using Meidcare, I don't think I've made claims that add up to what I've paid in that time.
Like you said, it only takes one big claim to change everything, but so far so good.
Welcome to the Club, many self employed US families were forced to join a decade ago. Most self employed families saw their premiums double overnight with Obamacare. More importantly, reasonable family deductibles were exchanged for massive per person deductibles.
The result is now a $40K outlay for small families paying full freight, before insurance kicks in for any one person. That is pricey for a successful self employed MD, JD, engineering or MBA consultant. It leveled independent truckers, hairstylists and everyone in between. A decade later, everyone's costs have soared.
Your wish is shared by all, but it misses the math. Nearly 1/3 of Americans, outside of Medicare, now pay nothing or little for their healthcare. Medicaid enrollment has exploded. CA alone has more Medicaid enrollees, than the entire populations of 40 US states. Medicaid reimbursements are so low, someone has make up the difference.
Obamacare was the perfect storm. It killed affordable catastrophic plans, as it ended many affordable Sole Practitioner MDs, ironically forced to sell their practices or go Concierge, due to their insurance costs and Obamacare compliance costs.
Meant to cover roughly 20 million people with preexisting conditions, it would have been far cheaper to hand them federal medical credit cards, and let them see anyone necessary. Obamacare was the equivalent of car insurance covering oil changes and tire replacement, or home insurance covering new a living room sofa and paint, annually. US cars have minimum safety standards. We do not require drivers to purchase Range Rovers or Mercedes, rather than a small Kia.
Competition, AI and a return to paying routine costs out of pocket, along with an affordable catastrophic plan for all, is our best hope.
Try CrowdHealth. It's crowd-sharing for medical care. I have no financial ties to them, have only seen presentations about it.
It seems to be a great option if you don't qualify for ESI, Medicaid, ACA "Marketplace" or Medicare. They seem to have gotten quite good at keeping costs down yet covering essentials while keeping costs under around $500/month for a family.
Of course, the real test of any insurance/crowdshare scheme is how well you're covered for a catastrophic event. They claim they do well, but I can't vouch for it.
Worth checking out.
IMO, free market options like this beat the hell out of expanding government in any way. We need to get government the OUT of medical care as much and as fast as possible before it bankrupts both the nation and families within.
How much are we willing to pay? Because it costs a lot. Medicare is in more trouble than Social Security.
Part of the ACA which was dropped was taxing cadillac plans. Nonetheless employers who give Cadillac plans still have to state the value on the W2 yearly, one of many tiny numbers we never look at. Except I do, because I used to do the taxes for the business, (very poorly). $41,000 a year, tax free.
We also need a way to keep costs reasonable. My insurer is also my health care provider, and they have all kinds of protocols to go through before the expensive option. Still, if you get cancer, we are talking hundreds of thousands and I've stopped looking at the numbers on the bills we don't have to pay anyway.
Everyone is making a ton of money. Pharma, hospital groups, insurers, heck nurses, nurse practitioners, physical therapists, etc are all in the neighborhood of $100. Docs are even way more.
Good luck. I and tons of other small tradesmen canvassed and phone banked and Obama was our hero. This is what we got. Good luck to you and I wish you to make it to 65, and that the kids if you have them get coverage.
So, if I follow the logic, costs go down if we change who pays for insurance. Therefore, we don’t need to improve building codes to reduce fire and wind damage, just have the government pay the bill. Seat belts are also unnecessary, as are bumpers that can withstand low-speed impact. Think of all the money we could save on housing and automobiles.
There are lots of reasons that U.S. healthcare costs are so high. Incentives are terrible for consumers and providers for one thing. Another is lifestyles. We are fat. Grossly, horribly, fat. We build neighborhoods without sidewalks. We eat garbage. We provide food assistance for empty calories. According to the OECD, the average obesity rate for age 13+ among the OECD13 is 26%. In the United States it is 41%.
Fixing insurance costs is difficult and complicated. It requires overcoming vested interests and the unwillingness of Americans to change their habits. We also need to stop funding negative behavior.
Does anybody really believe that Americans died during the pandemic from not wearing masks? Is it possible that the elevated incidence of diabetes and related maladies caused Americans to be exceptionally vulnerable? I think so.
Unfortunately, partisanship is the root cause of our inability to fix healthcare just as it is the cause of everything else. There are no good ideas, only theirs and ours.
You do John « At the same time, let’s implement some market-oriented ideas to reduce unnecessary regulations, increase price transparency and competition, and discourage excessive tests and other expensive treatments that provide little benefit relative to their cost. »
Ultimately, unhealthy people are expensive to insure. Solutions don’t necessarily need to be market based, although some should be. The rules for providing health savings accounts are still too complex. We could do a lot there to save costs, perhaps something along the lines of an Earned Income Tax Credit for healthcare. Changing the food pyramid was a good step, even if inelegantly accomplished. Changing food assistance could create a healthier population and save a lot of money. Aggressively fining healthcare providers who refuse to be transparent is another. We can bring back exercise in schools instead of drugging kids. How about a healthcare system instead of a sickcare system?
As far as social insurance, Canada and the U.K. have terrible systems that ration care and access. Germany and France seem better to me and more suited to America. Even Switzerland. An expensive system would save America about a trillion dollars a year.
One last thing. Obamacare provides subsidies to wealthy people who do not work. It is designed to be gamed. If you are paying a lot, you need to up your game.
My weight doesn’t have anything to do with a hospital stay costing $1 million in the US that costs $300k in Europe and $100k in Mexico and India for the same procedure.
Yes, if we use hospitals more than other countries, the volume-based costs are related to our general health. The problem is the cost per use.
Young people who have never smoked or drank or done drugs and who exercise regularly have cut out processed meats and are otherwise healthy. Get cancer of the kind that will kill you unless both treated and a huge amount of luck.
You can't blame people for getting sick. No one wants to get in an accident.
According to the World Bank, the percentage of diabetes prevalence for age 20 to 79 in the United States is 13.7. That compares to Haiti at 8.5. In Kenya it is 3.1. In France, where obesity is low, it is 5.1. If we were to reduce diabetes in the United States, we would improve human wellbeing and free up money for other purposes. Most accidents are paid through auto, homeowners, and other liability insurance. Either way, our unhealthy society is really expensive.
Many (most?) people with employer sponsored health plans also face increasing costs and high deductibles. that's part of why we are so angry and medicare for all is so popular. Let people buy into medicaid - do we need another separate public option? and guess what, let employers buy into it too.
the "if you like it you can keep it" argument has lost some of its luster because you can't keep it even if the government does nothing. your employer is going to raise premium shared costs and shift benefits costs to you through higher deductibles and copays every year. we don't have to move everyone to "medicare for all" in one swift swoop. make it optional and see how long it is until we all move there as long as the benefits are good and costs to participants stay low.
Except the pesky problem of the program slowly going bankrupt. Adding 100 million participants at $200/mo will just make it happen this year instead of 2030 or so.
60 years or so ago, insurance was mostly for hospitalizations or catastrophic reasons. Our family doctor had one nurse in his office and no other staff. My mom directly paid the Doc. We were working poor, but my family had no problem paying the bill because it was reasonable. Once insurance starting paying for routine or sick visits, a monster called bureaucracy took over everything. The health care system created lots of jobs to bill payments, process payments, monitor payments, negotiate 100s of different contracts which means prices vary, etc.
Also, I have witnessed the mindset change for people with insurance as most go to doctor for any minor reason which increases insurance premiums eventually. The mindset change also clogged doctor offices causing a shortage of doctors which created urgent care centers (more bureaucracy costs).
Quite frankly, it's a mess. Perhaps the only way to fix it is to return to the old ways which worked. Eliminate all insurance but for catastrophic.
As an aside, you are one of the few journalists remaining who tries to be unbiased. We desparately need folks like you.
Thank you, Suzanne. Appreciate you reading and the nice comments. Don’t think anyone can fully eliminate bias but worth a try! Cheers.
A simple change suggestion. Charge a cash paying patient/customer the lowest price, not the ridiculous high charge that insurers reduces based on contracts.
Bravo Suzanne .Your experience was widely shared, even 15 years ago. Our building contractor, had catastrophic plan for his workers, and negotiated affordable visits with a local sole MD for his workers, based on a minimum number of visits.
The MD knew he had a base, the workers could afford a routine visit when needed, and they were covered for major needs, that rarely arrived, because most were mostly young and healthy.
FELLOW BALTIMORON HERE. THIS IS THE MOST BALTIMOREY SENTENCE: Of course, one could simply forego paying this extortionist fee for the peace of mind of hopefully not croaking from the financial stress of landing in the ER after an uninsured motorist T-bones you drag racing on the streets of Baltimore because the authorities don’t enforce traffic laws anymore.
I'm in a similar boat. Recently unemployed. We ponied up for COBRA which we knew was going to be expensive, but not DAMN THAT'S EXPENSIVE expensive.
When I read that sentence I thought I was reading Jeff Maurer for a minute.
U.S. health insurance policy was settled a decade earlier than you seem to think. It was during WWII when it was decided by the federal government that employer-provided insurance would be tax deductible for the business, but not for individuals (while in the duration of the war wages were also tightly controlled). The 50s were the height of union membership, and unions could negotiate for better benefits as well as wages, all on the assumption that near lifetime employment with one company would be the norm. But retirement benefits were not universal though, so Johnson's Great Society expanded SocSec with the creation of Medicare. At that time, healthcare costs across the economy were about 5% of GDP. Today it is around 17% of GDP. With PPACA, I lost great insurance because it was a dreaded "Cadillac plan" and to boot had to pay a greater share for less!
We have a crappy healthcare insurance market - no doubt. That is due to it not being at all like every other insurance market in the country, and that is because of first and foremost the tax policy going back to WWII and the idiot insistence on corporate (and government) paternalism.
the "cadillac" tax was never implemented. Your employer changed your benefits to save money and blamed "obamacare"
Repealed before fully implemented - true. But employers act based on expectations, and in 2015 or 16, the expectation was it would be in effect. It was part of PPACA as passed, just like the infamous "penal-tax" for individual non-compliance. The fact that these provisions got piece-meal removal speaks to how ill-considered the whole venture was to begin with.
The penalty for not purchasing would have been paid by very few b/c it had to do with affordability as a percentage of income and you could make well over $100k per year and the premiums, even back then, weren't affordable, under THEIR definition.
The amount of the penalty is trivial compared to the principle of it. Kinda like the old line about if you've got nothing to hide, then why not allow the government to search whatever it wants?
You've captured the essence of the problem nicely. Our system evolved from the unintended consequences of a well-intentioned law, and now not only employs huge numbers of people but is also a major sector of the economy. As you say, it's complicated, and anyone promoting some sort of "magic bullet" simple solution is selling snake oil. That's true on both the left and the right.
The problem is I don't think any of the members of congress have the brains or the desire to forge real solutions. With a few exceptions, we could replace them with robots since they're only there to vote how their party tells them and to stick to the talking points.
Maybe it has always been that way and it's just more visible now due to social media. I don't know. But it doesn't look good.
A genuine mess. The exchange plans are 1) expensive (per month payment) plus 2) high deductible. The triple wammy of course is that the "insurance based costs" are oftentimes not cheaper than cash price, so you're paying a lot for a service (that accumulatives under your deductible, which is super high). Basically, plan on paying monthly + your deductible + co-insurance (up to the out of pocket max). For a family this will be $30,000, roughly? (Your contribution to the new medical facility and non-profit CEO compensation.)
Welcome to Obamacare. The legislation they fought so hard to pass and that he wanted his name attached for his legacy.
They really stuck it to the middle class and claimed is a great victory. Victory for who? Their donors?
There is one reason to actually sign for even a high deductible plan. Instead of being billed for the "list price" that almost nobody pays, you are billed at the much reduced insurance company rate. That's included in the plan because insurers don't want you to reach the deductible where they would have to start paying.
No insurance with the higher billing rate is a quick trip to bankruptcy.
I doubt this approach will do much and putting everyone on the very inefficient government plan isn't fiscally feasible. We need to blow the whole thing up, have people pay for basic care and have catastrophic insurance that prevents medical bankruptcy, removing the huge number of middlemen and administrative overhead that is swamping the system.
We need more competition. Obamacare was designed to create hospital monopolies and reduce competition from privately owned surgical centers.
Insurers exist to negotiate rates, not really to “insure”. With less competition there is no room on rates - most physician practices have been acquired by hospitals.
Almost all large employers self-insure. They hire the insurance companies only to create networks, negotiate rates, prevent fraud (which Medicare annd Medicaid are horrible at) and administer payments.
In an ideal world world the whole country would self insure, be able to seek treatment nationally at centers of excellence (rather than be forced to stay in state or in substandard networks by Obamacare) and we’d use insurers to negotiate rates and set up networks and weed out fraud.
Of course this is expensive. If your employer is paying $20k a year for insurance or you are paying $20k a year for Obamacare, the math says that your taxes are going to go up by $20k in a national self-insured program. There is no free lunch.
The only way to reduce costs is to increase competition and negotiate harder. This will mean more inconvenience and less choice (eg if the government says there are 1 million MRIs in a region annually and puts out a bid to contract for those at $500, chances are you won’t be going to your local hospital for the MRI- unless you want to make up the cost difference out of pocket.
A fundamental problem is that hospitals are hugely important local employers, the administrators s and staff are loyal voters, the nurses unions and the SEIU are huge political donors, etc.
They don’t want more competition, nor do the pols that get paid by those special interests. That’s why any state run system is always run for the benefit of the employees and unions, not the customers (see also, public schools and the NHS). I lived in Britain for many years and used the NHS. We don’t want that.
Hospital costs in the US are way out of line vs global norms and are the bulk of healthcare expenses. Pharma is only 15 percent.
The Repubs back Pharma generally and the Dems back hospitals. Doctors used to be Repub, but now that the majority of care is run by hospitals, that is changing.
We are never going to get more costs until we increase completion and we aren’t going to get that as long as the pols are paid by the hospitals.
And, with the advent of AI, people can take on more of their own care. I got an MRI and doctors wanted to do an expensive guided ultrasound for $7500 out of pocket. I asked AI to diagnose from it and learned i just needed PT, it gave me exercises and in a couple of months I was good as new. Doctors aren't trained to help people help themselves. There's no money in it.
An excellent and concise summation of why we are where we are regarding health care in America.
I laugh when I hear "Medicare for all." We HAVE Medicare for all. Everyone who gets a paycheck gets Medicare payments deducted. Combined, the employer and employee pay nearly 3%. You pay that for you entire career, yet get no healthcare services. The good news is, when you turn 65, now it's all FREE! Ha ha, just kidding. No, you pay about $200/month until you die. Well, at least all your healthcare costs are covered. No, they aren't.
I turned 65 and went into Medicare just as Obamacare came into effect. Obama promised you could keep your doctor, and keep your insurance. He was lying his ass off. I didn't experience the pleasure of trying to find affordable care under the Affordable Care Act. But everyone I know, and I mean everyone, cursed the friggin exchanges, and the increased costs.
President Reagan famously said that the most terrifying nine words in the English language are, "We're from the government and we're here to help."
No, Virginia, there is no such thing as a benevolent government.
You pay $200+ for Medicare premium for 80% coverage. To cover the other 20% you get a supplement at $300+ a month. A prescription plan costs $50-$100/month with $2,000 deductible. Then pay out of pocket for dental, vision, and hearing. I'm paying the most I've ever paid my entire life for health care since I've been on Medicare.
Technically, your employers took salary away from you to give you health insurance. You were paying for it, one way or the other. And the taxpayer was subsidizing you, because that benefit (income in kind) was tax free yet your employer got to deduct that expense from their taxes.
Medicare is a fraction of the price of Obamacare, at least.
I’m happy to be on Medicare now after 10 years on Obamacare where I spent $275k on premiums for my wife and I. Then again, I see from my little government worksheet that my employer and I also paid $400k in Medicare taxes over my lifetime.
I’m just thankful/blessed that so far I’ve never had to run up a 7 figure medical expense to offset the 7 figures I've paid into the system between my share of employer coverage, Obamacare premiums and Medicare taxes over my lifetime.
My primary comment was in respect to what politicians are promising - 0 premium, 0 co-pays, everything including dental, vision and hearing for 'free,' which is an enormous lie.
I haven't kept close watch, but in the 14 years since I started using Meidcare, I don't think I've made claims that add up to what I've paid in that time.
Like you said, it only takes one big claim to change everything, but so far so good.
Hope our good luck continues
Plus part B and C have 20% cost sharing right?
Welcome to the Club, many self employed US families were forced to join a decade ago. Most self employed families saw their premiums double overnight with Obamacare. More importantly, reasonable family deductibles were exchanged for massive per person deductibles.
The result is now a $40K outlay for small families paying full freight, before insurance kicks in for any one person. That is pricey for a successful self employed MD, JD, engineering or MBA consultant. It leveled independent truckers, hairstylists and everyone in between. A decade later, everyone's costs have soared.
Your wish is shared by all, but it misses the math. Nearly 1/3 of Americans, outside of Medicare, now pay nothing or little for their healthcare. Medicaid enrollment has exploded. CA alone has more Medicaid enrollees, than the entire populations of 40 US states. Medicaid reimbursements are so low, someone has make up the difference.
Obamacare was the perfect storm. It killed affordable catastrophic plans, as it ended many affordable Sole Practitioner MDs, ironically forced to sell their practices or go Concierge, due to their insurance costs and Obamacare compliance costs.
Meant to cover roughly 20 million people with preexisting conditions, it would have been far cheaper to hand them federal medical credit cards, and let them see anyone necessary. Obamacare was the equivalent of car insurance covering oil changes and tire replacement, or home insurance covering new a living room sofa and paint, annually. US cars have minimum safety standards. We do not require drivers to purchase Range Rovers or Mercedes, rather than a small Kia.
Competition, AI and a return to paying routine costs out of pocket, along with an affordable catastrophic plan for all, is our best hope.
Try CrowdHealth. It's crowd-sharing for medical care. I have no financial ties to them, have only seen presentations about it.
It seems to be a great option if you don't qualify for ESI, Medicaid, ACA "Marketplace" or Medicare. They seem to have gotten quite good at keeping costs down yet covering essentials while keeping costs under around $500/month for a family.
Of course, the real test of any insurance/crowdshare scheme is how well you're covered for a catastrophic event. They claim they do well, but I can't vouch for it.
Worth checking out.
IMO, free market options like this beat the hell out of expanding government in any way. We need to get government the OUT of medical care as much and as fast as possible before it bankrupts both the nation and families within.
How much are we willing to pay? Because it costs a lot. Medicare is in more trouble than Social Security.
Part of the ACA which was dropped was taxing cadillac plans. Nonetheless employers who give Cadillac plans still have to state the value on the W2 yearly, one of many tiny numbers we never look at. Except I do, because I used to do the taxes for the business, (very poorly). $41,000 a year, tax free.
We also need a way to keep costs reasonable. My insurer is also my health care provider, and they have all kinds of protocols to go through before the expensive option. Still, if you get cancer, we are talking hundreds of thousands and I've stopped looking at the numbers on the bills we don't have to pay anyway.
Everyone is making a ton of money. Pharma, hospital groups, insurers, heck nurses, nurse practitioners, physical therapists, etc are all in the neighborhood of $100. Docs are even way more.
Good luck. I and tons of other small tradesmen canvassed and phone banked and Obama was our hero. This is what we got. Good luck to you and I wish you to make it to 65, and that the kids if you have them get coverage.
"Part of the ACA which was dropped was taxing cadillac plans..." That was because the unions squawked.
And large employers/corporations. They use tax free health care benefits as a perk just as unions do.
Every plan would be a Cadillac plan now at today’s prices!
So, if I follow the logic, costs go down if we change who pays for insurance. Therefore, we don’t need to improve building codes to reduce fire and wind damage, just have the government pay the bill. Seat belts are also unnecessary, as are bumpers that can withstand low-speed impact. Think of all the money we could save on housing and automobiles.
There are lots of reasons that U.S. healthcare costs are so high. Incentives are terrible for consumers and providers for one thing. Another is lifestyles. We are fat. Grossly, horribly, fat. We build neighborhoods without sidewalks. We eat garbage. We provide food assistance for empty calories. According to the OECD, the average obesity rate for age 13+ among the OECD13 is 26%. In the United States it is 41%.
Fixing insurance costs is difficult and complicated. It requires overcoming vested interests and the unwillingness of Americans to change their habits. We also need to stop funding negative behavior.
Does anybody really believe that Americans died during the pandemic from not wearing masks? Is it possible that the elevated incidence of diabetes and related maladies caused Americans to be exceptionally vulnerable? I think so.
Unfortunately, partisanship is the root cause of our inability to fix healthcare just as it is the cause of everything else. There are no good ideas, only theirs and ours.
For sure, you need more cost reduction policies included in any new effort, which I suggest in the piece. Thanks.
You do John « At the same time, let’s implement some market-oriented ideas to reduce unnecessary regulations, increase price transparency and competition, and discourage excessive tests and other expensive treatments that provide little benefit relative to their cost. »
Ultimately, unhealthy people are expensive to insure. Solutions don’t necessarily need to be market based, although some should be. The rules for providing health savings accounts are still too complex. We could do a lot there to save costs, perhaps something along the lines of an Earned Income Tax Credit for healthcare. Changing the food pyramid was a good step, even if inelegantly accomplished. Changing food assistance could create a healthier population and save a lot of money. Aggressively fining healthcare providers who refuse to be transparent is another. We can bring back exercise in schools instead of drugging kids. How about a healthcare system instead of a sickcare system?
As far as social insurance, Canada and the U.K. have terrible systems that ration care and access. Germany and France seem better to me and more suited to America. Even Switzerland. An expensive system would save America about a trillion dollars a year.
One last thing. Obamacare provides subsidies to wealthy people who do not work. It is designed to be gamed. If you are paying a lot, you need to up your game.
Thanks John for your thoughts.
My weight doesn’t have anything to do with a hospital stay costing $1 million in the US that costs $300k in Europe and $100k in Mexico and India for the same procedure.
Yes, if we use hospitals more than other countries, the volume-based costs are related to our general health. The problem is the cost per use.
Like everything, there are many reasons. Obesity, pardon the pun, is the elephant in the room.
Young people who have never smoked or drank or done drugs and who exercise regularly have cut out processed meats and are otherwise healthy. Get cancer of the kind that will kill you unless both treated and a huge amount of luck.
You can't blame people for getting sick. No one wants to get in an accident.
According to the World Bank, the percentage of diabetes prevalence for age 20 to 79 in the United States is 13.7. That compares to Haiti at 8.5. In Kenya it is 3.1. In France, where obesity is low, it is 5.1. If we were to reduce diabetes in the United States, we would improve human wellbeing and free up money for other purposes. Most accidents are paid through auto, homeowners, and other liability insurance. Either way, our unhealthy society is really expensive.
How often does that happen?
Chances are it will happen to you. Most guys have about a 50% chance either via accident or health.
Many (most?) people with employer sponsored health plans also face increasing costs and high deductibles. that's part of why we are so angry and medicare for all is so popular. Let people buy into medicaid - do we need another separate public option? and guess what, let employers buy into it too.
the "if you like it you can keep it" argument has lost some of its luster because you can't keep it even if the government does nothing. your employer is going to raise premium shared costs and shift benefits costs to you through higher deductibles and copays every year. we don't have to move everyone to "medicare for all" in one swift swoop. make it optional and see how long it is until we all move there as long as the benefits are good and costs to participants stay low.
Except the pesky problem of the program slowly going bankrupt. Adding 100 million participants at $200/mo will just make it happen this year instead of 2030 or so.