Not to go into something deep and philosophical here, but let me give my personal experience so far.
Every plan I’ve looked at has worse coverage overall and/or costs more than our current insurance. And we had terrible coverage before that was amongst the most expensive available (due to pre-existing conditions). Oh, the new plans have lots of stuff thrown in (i.e., mandated by the ACA) that we don’t care about or are of at best minor financial benefit. But finding a plan that includes our doctor (more on that in a moment) and covers out-of-network providers as well (we don’t mind paying more out-of-network, but we do want freedom to go to whatever doctor we choose) is near impossible.
This is all complicated by a complete breakdown in the technical implementation of the shopping mechanisms for plans. I say mechanisms because this isn’t just that the Healthcare Exchanges weren’t (and still aren’t) ready for real customer use. Existing online sales channels such as eHealthinsurance and individual company websites are also having problems. For example, I finally found a (very expensive) policy that looks acceptable but access to their list of doctors for 2014 is broken. I can’t make any decisions until I can access that list. Even when the exchange works the designs suck. The Colorado one doesn’t let you filter on HMO vs. PPO vs. EPO, for example. And the comparison page doesn’t list the out-of-network benefits. Indeed out-of-network information is very limited on the site overall.
In searching for plans I’ve also noticed how some providers have really narrowed their involvement in the health care system. Anthem Blue Cross Blue Shield is only offering HMO plans, with no out-of-network benefits. Anthem used to be a great provider of PPO plans. And no one has combined HSA with Gold-level PPO plans, you have to take lower tiers of coverage in order to be able to use an HSA to cover your out-of-pocket costs.
“So keep your existing insurance”, you say. “President Obama promised you could”, you say. Sorry, our existing carrier is winding down operations and will go out of business in March 2014. “President Obama promised you could keep your existing doctor”, you say. Well, at best maybe. It looks almost impossible to keep our entire set of existing doctors. And it looks like our choice of doctors in the future will be very limited.
Obamacare “Affordable” Healthcare Act my A*&. Can you say GIANT CLUSTER F&^%? I can.
Venting complete. For now.
Hal's (Im)Perfect Vision 
I received the letter from the company’s insurance provider, United Healthcare, stating that our current policy ceases to exist after December 31 but they are “working hard with our employer” to provide new coverage. Translation: Higher premiums, higher deductibles, less physician choice and fewer benefits. I have heard this same story several times over and don’t personally know anyone that is impacted positively by the “affordable” care act.
My employer’s health care plan year runs from October 1 – September 30, so I was able to avoid the ObamaCare FSA limit change until now. Of course this exposes another Obama lie, “No tax increase on the middle class”. Yes, my taxes will go up several hundred dollars because of the FSA limit. In my new health care plan everything went up except our prescription co-pays. Of course, I don’t know how they’ve changed the drug formulary. These changes are in stark contrast to the no changes in cost and small benefit improvements we had in the past two years. Yes, there is nothing affordable about ObamaCare. I hate to think what will happen when the “Cadillac” health plan tax starts in 2017 or 2018.
Yup, I knew what a cluster F it would be back when it was rammed up our you know what in the middle of the night after no one could have reasonably read the entire thing. Not to mention that it has ballooned in size to several thousand pages of impossible to read regulations. Combine that with the need for a much bigger government bureaucracy to maintain this leviathan, and I think we can all see that we are all truly F’d. The direct costs through premiums are up, and the soft costs through taxes will certainly be up.
You think that the “lots of stuff thrown in” are of “at best minor financial benefit.”
There is an annual out-of-pocket cap — 100% coverage (no copays, no coinsurance) after the cap is hit. On top that, there is no annual limit. There is no lifetime limit. There is community rating and guaranteed issue.
Eliminate community rating, and the plan becomes much cheaper because it now covers only healthy people. Eliminate guaranteed issue, and the plan becomes even cheaper, because the insurer can use a minor error on your application as grounds for cancelling your coverage. Put in a lifetime cap, and you wash out your costliest customers after a few years.
Nobody ever thinks about these unseen factors when they select health insurance. But there’s no free lunch — insurance is just math. Killing off one cancer patient might save enough money to halve the premium for 100 other people. The costliest parts of Obamacare are the parts that you’ll never get any benefit from — you hope.
(And I’m not convinced it’s the right decision. Maybe we can’t afford to spend $5 million to save every life. Maybe we will never get medical costs under control unless we start abandoning the heroic measures that cost the most and provide only minimal benefit. But in a political climate with “death panels” rhetoric, there was no way Obamacare was getting passed with a limit in place.)
I’m sorry, but other than the no lifetime limit and guaranteed coverage the other features were present in the pre-Obamacare plans.
Ah, but no denying coverage for folks with pre-existing conditions is another big one. That’s the domino upon which all the others rest.
Both my wife and I have pre-existing conditions. When I lost my job a couple of years ago, we had to scramble to find something affordable (my former employer’s cobra was anything but affordable) to sign up for during the 63 day transition period.
When we came to this country from Canada 20-something years ago (during the runup to the Clinton attempt at health care reform), we were astounded and how screwed up the US healthcare economy was. The system functioned, but it was nearly incomprehensible and folks lived on the edge of having something go wrong, plunging them into bankrupcy.
The ACA is *far* from perfect, but it’s at least something. I don’t think anyone can predict how it will all settle out in the end.
Both my wife and I have pre-existing conditions as well, and we were forced into our state’s High Risk Pool. By law that policy was set at 20% more expensive than the average equivalent policy state-wide. The state did offer subsidies for low-income folks to make that more affordable, not that such a thing applied to us. So expensive policy, mediocre coverage.
We were lead to believe that under ACA people in our position would be able to get better coverage for lower cost, that is not the case. We are finding the policies to be more expensive and the coverage to not meet our needs. We may need to pay 30-50% more in order to get close to the coverage we desire. The main stumbling block is that we want to be able to choose our doctors, not be restricted to “in network”. I think that is a somewhat foreign concept to many who live in single-payer system countries. For example my wife went for some surgery where she read reviews on doctors then went and met with a few of them. Then she picked the one she wanted to use, set everything up, etc. She had the surgery on the date of her choosing within a very short time after having chosen the surgeon. Someone having the same surgery in England is assigned (with no choice on their part) a surgeon by the NHS and then waits months until they are given a surgery date. That system does not sit well with Americans. Indeed our experiment with HMOs back in the 70s largely failed, yet ACA appears to be forcing a return to an HMO model we already rejected. Yes my wife’s surgery cost us a lot more than people in England pay, but we are willing to pay something for our freedom to choose.
The problem with ACA is not the problems it is trying to address, it is the means by which it is trying to address them. The pre-existing conditions problem is that our pool sizes are too small, with insufficient numbers of low-usage participants to offset the high-usage participants. Of course we couldn’t try simple solutions, like allowing national pools instead of state-by-state pools. We had to add a weirdly-designed mandate and 10,000s of thousands of pages of laws and regulations. Or that our cost structure is too high, but I will argue that 90% of that problem is CAUSED by government regulation. ACA increases the cost structure, not reduces it. So we can never dig ourselves out of the problem.
30 years ago my primary care physician had a nurse. The nurse also answered the phone. There was a part-time bookkeeper. That was it. Now our PCP has 4 full-time office staff AND outsources scheduling and other activities to a service. Our doctor’s take home pay is less than many of his patients. We aren’t spending money on healthcare, we are spending money on government imposed bureaucracy.
The leading statins are now generic so the cost of this key drug class has come down, but one has to wonder why that wasn’t the case before they became generic. There were a lot of them on the market, perhaps as many as a dozen, yet they exerted almost no competitive price pressure on each other. The regulatory system works against competition. If it worked correctly drugs would be like disk drives. They have more leading-edge IP in them than almost any product in the world yet are priced as commodities.
There are lots of changes that could have been made that would have dramatically improved healthcare in the U.S., but ACA does little of that. Want another one? We regularly see procedures billed at $10,000+ reduced to $1000-2000 by insurance contracts. If you wanted to mandate something then Congress should have mandated that anyone who pays up front is entitled to the lowest price that the provider has negotiated with an insurance payer. Ditto for drugs. That simple a change would have suddenly made healthcare a lot cheaper for those with limited or no coverage. Instead we had (and still have) the perversion that those who can least afford healthcare actually pay the highest prices for it.
The United States government created the pre-existing condition problem when they tied health care to your job through tax policy. Without that tie, people would be covered by at least major medical for their entire lives with no breaks. The pre-existing condition problem *disappears*.
The reason drug prices and other prices do not go down is that market forces that would force them down have been undermined by government. Did you know that it is illegal for your doctor to consider your ability to pay when prescribing treatment? What incentive is there for producers to drive costs down when everybody has a birth right to the best possible treatment available whether they can afford it or not?
It’s the most basic economic principle there is: supply and demand. The US government’s health care policies have driven demand for health care through the roof, and prices have followed. Not shocking.
My god damn insurer is also doubling my family rate. I might as well just drop it until my family members or I get sick and just re-apply when we are.
Your existing carrier winding down, how is that related to the ACA?
They decided they were no longer necessary because of the new plans.
Sorry, Hal and others. Obamacare was exactly the wrong solution to our broken healthcare system. Our healthcare system has been broken by 70 years of government intervention, starting with tax treatment changes in the 1940’s (made as a favor to unions) that has led to health insurance being tied to your job. The solution is a Separation of Health Care and State. Unfortunately, Republicans don’t seem to understand what the solution is.
The history of the US is government intervening in the free market, causing problems, then blaming the problems on the free market as a pretext for further government intervention. Health care is a case study in precisely that. The idea that everyone has a right to all the health care they need whether they can afford it or not may sound good, but if implemented, it will mean quality health care in the US will be unavailable at any price.
No need to apologize to me 🙂
I don’t live in the US, so here’s an outsider’s perspective: the reason this looks so expensive to you is that for years, the US has effectively been getting healthcare cheap by ignoring those who need it but can’t directly afford it. Insurance only for those without a pre-existing condition. Businesses (able to offset against tax) offering the insurance plans to employees (who are healthy). Not supporting those people has a societal cost – which I see in the people wandering the streets in cities when I visit the US. You have an underclass which needs medical treatment of all sorts.
Even with that advantage of only serving the top whatever percent, US healthcare is unbelievably more expensive than any other western country (http://peltiertech.com/WordPress/graphing-the-cost-of-health-care/) – AND you have one of the highest infant mortality stats (https://en.wikipedia.org/wiki/Infant_mortality#In_the_United_States) outside the developing world. Those two numbers beside each other should worry you.
Now you’re providing a safety net for those who aren’t employed and/or aren’t well. Surprise! It’s expensive. The good news: if you keep doing this for a while, the costs will lessen. You’re getting all the problems at once.
It’s not a joke that in any country with universal health care (paid from income tax) the plot of Breaking Bad wouldn’t have happened, because Walter White’s cancer would have merited free treatment. OK, you lose a TV series, but you gain a high school chemistry teacher.
I don’t really want to make this a philosophical piece about health care, at least not in this blog. There are two separate questions here. One is if the U.S. Healthcare system was broken (almost everyone would say Yes) and the other is if the way it is being fixed is appropriate (where poll after poll, including those before Obamacare was passed, say No). Right now we are in a situation where we may have screwed up healthcare for 90% of the population in order to improve it for 10%, and it still isn’t clear that we really improved it for that 10%.
I’m sorry to hear that Colorado’s implementation seems to be less than desirable, but speaking for NY, premiums are down from $1000+ for the cheapest possible individual market plan to ~$300. On average, costs have been halved. It’s providing massive benefits here. California and several other large states are also showing significant cost reductions.
Your situation is not representative; each state is in a very different place, and if your income is high enough that you don’t qualify for any subsidies you’re already in the minority of people in the country.
This is what Ayn Rand used to refer to as the “range of the split-second” mentality. “My costs have gone down! There’s nothing else to consider! It’s just like Santa Claus!”
Why did your premiums go down? Is it because you are suddenly a healthier person? Did the expected value of your future health care expenditures suddenly drop drastically? Or is it because people like my friends, whose $3,000 per year insurance has just gone to $10,000 per year are subsidizing you? Or is it because young, healthy people who don’t want insurance are being forced at gunpoint to buy it anyway? Are things so good in NY and CA because they are reliable Democrat-voting states, and the subsidies are being tilted toward those states?
Obama care is a wealth redistribution scheme, pure and simple. Any such scheme is going to have winners and losers, at the arbitrary whim of the regime in power. The goal is not to improve health care; it is to destroy insurance companies so that single payer becomes the only perceived possibility.
Every problem with our health care system has been caused by government intervention over the last 70 years, and the solution is quite simple: Get Government Out. It’s the only solution that doesn’t violate my rights.
don’t defend insurance companies – they don’t deserve it.
You clearly don’t have the first clue what’s been going on in the US healthcare wise for the past 60 years. Medicare and Medicaid are programs that have addressed “people who need health care but can’t directly afford it”. And those programs, and the government regulation surrounding them, have driven demand for health care through the roof. When there are people who need health care but can’t afford it, *it creates an incentive for health care providers to either lower costs or provide cheaper but perhaps less effective treatment alternatives*. But everyone is entitled to health care whether they can afford it or not, and considering cheaper but less effective treatments is illegal. That’s a major part of the reason our health care system has been on the verge of breaking.
People who talk about “insurance only for those without a pre-existing condition” reveal breathtaking ignorance about what insurance is. If you are buying something that pays the costs of your pre-existing condition, what you are buying is not insurance; it is an entitlement. Insurance is a payment to indemnify risk. A pre-existing condition is a certainty, and cannot be insured against. As I’ve stated elsewhere on this thread, the US government created the pre-existing condition problem by tying health insurance to your job through tax policy. Without that tie, health insurance would be like auto insurance – completely independent of your job and something that no intelligent person would be without, at least major medical. Under that scenario, if you develop a serious medical condition in a state of being uninsured, you have only yourself to blame, and you shouldn’t be able to force your neighbor, at gunpoint, to pay for the cost of your carelessness. But that’s not the case for the vast majority of pre-existing conditions in the US. They came about because someone got a long-term medical condition at a time when they were working and then lost their job, quit, or retired. Whammo! Instant pre-existing condition.
The notion that people have the right to all the health care they need whether they can afford it or not may sound good to socialist-types, but the reality is that it will bankrupt our country and lead to a condition where government decides the prices that are paid for health care services, causing quality healthcare to be unavailable at any price. Innovation in health care will disappear. But those are the collectivist reasons to oppose Obamacare and other forms of nationalized health care. The main reason is: You don’t have the right to force me to buy health insurance against my will, no matter how many people vote for it. It’s called “individual rights”, something I wouldn’t expect anyone who isn’t an American to understand.
Provision of health care is not a function of government. If we were to separate health care and State, it would drive down the costs of health care for everyone. The poor and middle class would benefit the most. Rich people (and anyone with friends in the Democrat Party) will always find health care under any system. It’s the middle class and the poor that are the greatest victims of 70 years of harmful government intervention into health care in the US.
“The notion that people have the right to all the health care they need whether they can afford it or not may sound good to socialist-types, but the reality is that it will bankrupt our country and lead to a condition where government decides the prices that are paid for health care services, causing quality healthcare to be unavailable at any price. Innovation in health care will disappear.”
Why hasn’t it bankrupted all the other countries that do it? And conversely, even without universal health care, why does the US have the highest healthcare costs and yet one of the highest infant mortality rates?
You say “If we were to separate health care and State, it would drive down the costs of health care for everyone.”
You’ve largely tried that, and it manifestly hasn’t happened. Time to find something else, perhaps.
Here is a report on how health care spending in Canada is growing at an unsustainable rate:
http://dailycaller.com/2012/07/24/report-canadian-health-care-spending-unsustainable/
The only way to combat that spending growth is by rationing, which is common in countries with Socialist health care. We hear about patients waiting months for an MRI or days to get admitted into an emergency room. The US has high costs because government programs have driven up demand, government regulatory bodies like the FDA have driven up costs, government licensing of doctors has driven down the supply of doctors, malpractice law is a mess, and, as I believe I said before, the requirement that cost of treatment not be considered has created no incentive for providers to reduce costs. Look at a chart of when health care costs began to skyrocket in the US. The knee of the curve is 1965, the year Medicare and Medicaid were passed. The early 1960’s was the last time that the US had anything resembling a free market in health care.
As for touting infant mortality rates, the end doesn’t justify the means. “I’m sorry, healthy people and doctors, we are going to need to enslave you so that we can drive our infant mortality statistics down.” Uh, no.
We do need to try something different in the US – a healthcare system that recognizes the individual rights of doctors and American citizens. Once we have that, anybody who thinks they can reduce infant mortality is more than welcome to make suggestions, but those suggestions will be implemented voluntarily, not at gunpoint.
Guys, I live in France and I can tell you that a healthcare system is essential.
I didn’t spent a dime when my child was born.
I am never afraid of getting sick or going to see the doctor.
If I get an accident on the way to work, I do not pay a dime.
Through my company I have a complementary plan that refund me almost 100% of all expenses, even hospital.
More generally, people here have better vision and teeth than in the US. (I have been in Washington DC and was surprised how many people had bad eyes).
The problem is that US has to solve a big society problem and the system has to adapt. In one year from here, you will have forget about it.
David
Yeah, you don’t pay a dime. Your next door neighbor does.
What on Earth does the quality of people’s vision, which is hereditary, have to do with health insurance?
“I didn’t spend a dime…” You can’t possibly mean that. You pay for it in higher taxes and restricted freedom. And as Eric said, your neighbors help pay your share as well. Reminds me of that audio clip of a woman during Obama’s first campaign when she was saying how great it will be if he becomes President because she won’t have to worry about paying her mortgage or putting gas in her car. She might not, but now the rest of us do.
Everyone here is ignoring two things. 1: A major reason more money is spent on healthcare here than in other countries is due to our lifestyle choices. Too many of us are fat. In other countries it is common to actually walk or ride bikes. 2: Part of the reason for requiring health care insurance from everyone is because too many choose not to actually purchase insurance until they need it. Literally 80% of the under 30aged patients I saw did not have insurance because….they were healthy and didn’t expect to need it. When they do get into an accident, the ambulance is expected to scrape their bleeding carcass of the road and the ICU is expected to plug them in and keep them alive. If all of them had been paying premiums, few would need it but the contributions keep insurance costs down for everyone. When people are allowed to only purchase insurance once they need it, then costs go up. Under the previous system, there was no incentive for young people to pay for insurance rather than for their expensive unlimited phone plans, restaurant meals and cable TV. If something bad happened they would get taken care of and since they don’t own a home…well going bankrupt is inconvenient, but not a big deal. (I’ve watched my irresponsible baby brother do it twice.) I also witnessed a 50 something year old come to rehab fully expecting us to solve all of his equipment issues for him because he did not have insurance to pay for it. He had two fairly new paid for cars and a paid for home as well as a sizeable annuity all of which prevented him from qualifying for various community programs we would typically use. His reason for no insurance? He thought paying for the $400 a month COBRA for a few months between jobs was too much to ask. (Notice he did manage to pay off his cars and his house though.) Tough luck, you say? Just don’t give him the equipment or make him pay for it…..That’s what you are thinking. WRONG! We cannot discharge the bum without the proper equipment. He was missing a leg so a w/c is kind of critical. So when he insists he can’t purchase a W/C we have to solve the problem or just keep him in the hospital which is far more expensive than buying a W/C. This is the reason it is not OK to let people run around without insurance. Too many won’t take responsibility and yes we are required to give them what they need whether they have insurance or not.
Paul, you’re making my point for me. It is precisely because our governments have passed laws that allow people to escape the consequences of their bad decisions that our health care system is in the shape it is in. If you make unhealthy lifestyle choices, *you* must be the one and only one that suffers financially for that, through higher insurance costs. Choosing not to buy insurance should mean that you get only the care you can pay for when you get sick or hurt. Laws that require hospitals to care for people when they can’t pay for it should be repealed. Let’s not use the bad decisions that were made over the last 70 years cause us to make an even worse decision.
So, if we repeal the laws that require hospitals to care for people when they can’t pay for it… where do you draw the line on that? Suppose, you are a passenger in a vehicle that has no insurance and you crash into a tree on public property, your unconscious and dying. Should the ambulance run a credit report before they bring you to the hospital? At what point are you “good enough” that the hospital can stop treating you… that’s is what the Laws are defining.