Health insurance no longer effective safety net

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.

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A personal perspective on Obamacare

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.

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Riding A Hobby Horse

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 . . . ]

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On the failures of Obamacare

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.

Continue ReadingOn the failures of Obamacare