I often wonder about studies showing that Americans are spending less on health care. It seems to me that many of us are now buying cheaper health policies with huge deductibles, then putting off health care because much of it is coming out of pocket. This NYT article was thus interesting to me.
The number of uninsured Americans has fallen by an estimated 15 million since 2013, thanks largely to the Affordable Care Act. But a new survey, the first detailed study of Americans struggling with medical bills, shows that insurance often fails as a safety net. Health plans often require hundreds or thousands of dollars in out-of-pocket payments — sums that can create a cascade of financial troubles for the many households living paycheck to paycheck.
These financial vulnerabilities reflect the high costs of health care in the United States, the most expensive place in the world to get sick. They also highlight a substantial shift in the nature of health insurance. Since the late 1990s, insurance plans have begun asking their customers to pay an increasingly greater share of their bills out of pocket though rising deductibles and co-payments. The Affordable Care Act, signed by President Obama in 2010, protected many Americans from very high health costs by requiring insurance plans to be more comprehensive, but at the same time it allowed or even encouraged increases in deductibles.
John Oliver describes Big Pharma marketing to doctors and patients
My family just signed up for an extremely expensive “Bronze” policy with Obamacare. It is shameful that there are only two companies “competing” for our dollars in St. Louis (it’s worse than shopping for a phone company). It’s shameful that none of the policies in the bronze or silver range include Barnes Hospital (St. Louis’ premium teaching hospital) in their network. It shameful that even though we are paying $1,000/month for a family of four, that the annual deductible is in the range of $4,300 for indiv and $8,600 for family, with annual out-of-pocket deductible for our family being $12,700. There is no real competition here, and I have yet to see the any reason to believe that the ACA will pressure providers to lower their costs. In America, we pay many times the amount for basic services (e.g., MRI scan) than people in other countries. Our economic side of our hospitals, including “non-profit” hospitals, are a joke, with their executives getting exorbitant salaries while they are on a shopping spree to buy up the local medical practices so that there is no meaningful competition, even your local doctors. I recognize that the ACA forces insurance companies to provide certain minimum coverages and that they can no longer cherry-pick patients based on pre-existing conditions, which was rampant and immoral. The ACA is certainly better than nothing.
The most shameful thing of all, however, is that even with the faults of Obamacare, the Republicans want to destroy the modest protection it offers many of us, and the substantial protection it offers low-income families. They propose to replace it with nothing at all. The Republican proposals I have seen would send all of us back to ravages of the dog-eat-dog for-profit health market where cherry-picked customers pay unregulated prices, where premiums have been skyrocketing for decades, where many folks are offered paltry coverage that they have no way of paying for, and where many people are deemed “uninsurable.” If politicians can only convince us to keep watching lots of sports events and movies, maybe we will never force them to enact meaningful reform.
We need single-payor coverage, like most other civilized countries. For more on the dreadful situation we currently have, check out Stephen Brill’s excellent article.
I’ll end with this somber reality from Brill’s article:
The health care industry seems to have the will and means to keep it that way. According to the Center for Responsive Politics, the pharmaceutical and healthcare product industries, combined with the organizations representing doctors, hospitals, nursing homes, health services and HMO’s, have spent $5.36 billion since 1998 on lobbying in Washington. That dwarfs the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by oil and gas interests over the same period. That’s right: the health-care-industrial complex spends more than three times what the military-industrial complex spends in Washington.
Hobby Lobby is suing to be exempted from certain provisions of the Affordable Care Act. The Supreme Court has agreed to hear the case . . . The question at the heart of this is, should a company be forced to pay for things with which it has a moral objection? [More . . . ]
I’m reading a lot about the recent problems with Obamacare. For everyone complaining about this new program, however, I would ask “You say Obamacare is bad, but compared to what?”
I’m on COBRA, having left a job a few months ago. I shopped around on the open market PRE-Obamacare. The prices were already high, even for high-deductible coverage. My wife, who walks briskly every day and who is in very good health was deemed uninsurable because of four separate reasons, all of which were total bullshit (one was that she broke her ankle last year, and it had substantially healed by the time we applied for coverage). The for-profit insurance companies have been out there cherry-picking and leaving families in desperate straights. I know of one family that has been paying almost $40,000/ year because two children are fighting depression and the husband has some physical injuries (though he is working). This is all PRE-Obamacare. For all of those people who want to blame Obamacare I would like to remind them that things were terrible before Obamacare. Coverage was shrinking and prices sky-rocketing BEFORE Obamacare.
Not that I’m a big fan of Obamacare–we need Medicare for all–some reasonable level of care for all Americans, combined with many of the strategies offered by “Bitter Pill,” the blockbuster Time Magazine article published a few months ago. We were lucky to get anything at all accomplished in Congress given the abject corruption. There are many aspects of the so-called health care system that need immense rehab, and Congress is not up to the task. Half of Congress wants to destroy Obamacare and replace it with “Fend for yourself, and good luck not getting fleeced by huge profit-driven companies, including all of those huge “non-profit” hospitals who are gobbling up your favorite doctor’s medical practices.”
I fear for many people out there. Too bad ordinary folks can’t afford lobbyists. If they did, we could bring some sanity to the prices charged by many providers and Big Pharma. Finally, as Dylan Ratigan has written, we also need to reconceptualize health care as “Help me, my family and friends live long and prosper” instead of “Don’t let me or anyone I know die.” We need to have courage to face our deaths with dignity in order to reset our priorities in a meaningful way, but there is no sign that this is likely.
Here’s another excellent and succinct analysis by Dylan Ratigan, part of an mass emailing he recently sent out. Allowing conservatives to argue about “death panels” is a big mistake and here’s why — and BTW, the time to make policy is not as we gather around very sick people challenging each other as to who can spend the most to to extending someone’s last breaths by 3 months, bankrupting healthcare in the process. We need to grow up and get our heads out of fantasy-land. Let’s redefine healthcare in terms of sustainable and meaningful goals. Ironically, there is date that those who claim to be most confident in the existence of an afterlife insist on the highest rate of last-minute desperate expenditures. Here’s Dylan’s email:
Generally speaking, there are only two ways to earn money.
1. Charge a fee for goods or services.
2. Charge a mutually agreed upon percentage based on a future outcome based on the newly created value. This percentage can be in the form of equity or commission.
As it stands, healthcare in America is based on the first model. This creates a system with many, high fees generated by acute and traumatic care. The chart above, from this report by the International Federation of Health Plans, shows how much we are paying compared to the rest of the world:
In reality, this care is for only 5 percent of us at a given moment, yet accounts for 50 percent of what each of us spend on the service regardless of whether or not we are using it.
If this unfortunate reality upsets you, please relax…close your eyes….and imagine for a moment a healthcare model that uses the second model of income generation. One that is based on equity or commission based on a future outcome.
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Here’s what’s on my mind. Many of us care deeply about social and political issues, and it does feel good to clarify each other’s thoughts here on FB, but it doesn’t change politicians views. I’ve ranted about U.S. warmongering online for almost a decade, and it hasn’t changed America’s obsession with war as the first tool of choice for attempting to “fix” social conflict.
Last week, I got a robocall from a voice that told me that Obamacare is going to destroy the United States. I don’t believe that. I also believe that Obamacare is full of flaws (I think the U.S. should guarantee ALL citizens a reasonable minimum level of health care doing an end-around private insurers, based on what is sustainable in terms of the overall budget–I would much rather prefer Medicare for all to Obamacare).
This robocall said to “Hit 1, to be transferred to Senator Blunt.” I hit 1. A man from Roy Blunt’s office answered the call and proceeded to horribly misrepresent several aspects of Obamacare. He proceed to tell me that his poll of choice showed that people from Missouri are heavily against the things offered by Obamacare. I told him that I didn’t trust the methodology and that I know 1,000 people who are not against the things offered by Obamacare. He tried to get off the phone. I challenged him to stay on the phone. I asked him whether there weren’t SOME decent aspects of Obamacare, such as eliminating exclusions for pre-existing conditions. He hemmed and hawed. He told me that costs will go up under Obamacare. I responded, “Costs for health insurance rose throughout the 8 years of George W. Bush. They go up regardless of who is the President.” I kept this twerp on the phone for 5 painful minutes (painful for both of us), and challenged Senator Blunt to do SOMETHING so that in a nation that has more resources than most, we don’t have people dying for lack of medical treatment. He actually seemed to be agreeing with me a bit at the end.
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This article at Common Dreams is ostensibly a discussion about hernia repair surgery, namely, an option to be treated more humanely and cheaply in Canada than in the U.S. The discussion turns to deeper criticisms of the American way of providing healthcare, however.
Too many general surgeons and hospitals have on average over 10 times the rate of recurrence, four times the rate of infection, and often use expensive mesh both to replace lack of surgical skill and to speed up the operation. Plus they charge much more before they quickly say “sayonara.”
The Shouldice [Hospital, outside of Toronto] procedure is described by hospital officials as a “natural tissue repair that combines the surgical technique with the body’s natural ability to heal,” and takes, on average, forty-five minutes to complete. Except in rare circumstances, “the technique does not use artificial prosthetic material such as mesh because mesh can introduce unnecessary complications such as infections or migration, dramatically increasing the cost of the operation. Shouldice does not use laparoscopic technology because of the potential intestinal punctures and bladder and blood vessel injuries, which may lead to infection and peritonitis.” Shouldice staff note that laparoscopic surgery also requires general anesthesia and hugely higher costs for disposable items per surgery than is the case at their hospital.
There are about one million abdominal wall hernia operations yearly in the U.S. Hospitals and general surgeons for the most part do not use the Shouldice Procedure. Still the deplorable “quick and dirty” that invites overuse of mesh – about 80 percent of the patients – has become a perverse incentive for higher billings in the United States. Superior talent is needed for the more natural procedure used by Shouldice.
These numbers from the Miliman Research Report are stunning. This situation cannot possibly be sustainable for most Americans, and I have little faith that the Affordable Care Act will reduce these costs. I want to believe that the ACA will address costs, but I simply can’t believe this. It’s also amazing that in light of these numbers, and in light of the recent blockbuster Time Magazine article, “Bitter Pill,” America seems incapable of having a rational conversation about what it really needs to do to reduce these horrendous costs.
Last year, when healthcare costs for the typical American family of four exceeded $20,000 for the first time, the Milliman Medical Index (MMI) compared the cost of a family’s healthcare to the cost of an average midsize sedan. This year, with costs exceeding $22,000 ($22,030), we note that healthcare costs for our family of four are almost as much as the cost of attending an in-state public college ($22,261) for the current academic year. The total share of this cost borne directly by the family—$9,144 in payroll deductions and out-of-pocket costs—now exceeds the cost of groceries for the MMI’s typical family of four. The out-of-pocket cost alone—$3,600 for co-pays, coinsurance, and other cost sharing—is more than the average U.S. household spends on gas in a year.