This is the talking point I’m seeing starting to crop up. And here’s the counterpoint:
Health Insurance Coverage and Health — What the Recent Evidence Tells Us http://www.nejm.org/doi/pdf/10.1056/NEJMsb1706645
One question experts are commonly asked is how the ACA — or its repeal — will affect health and mortality. The body of evidence summarized here indicates that coverage expansions significantly increase patients’ access to care and use of preventive care, primary care, chronic illness treatment, medications, and surgery. These increases appear to produce significant,multifaceted, and nuanced benefits to health. Some benefits may manifest in earlier detection of disease, some in better medication adherence and management of chronic conditions, and some in the psychological well-being born of knowing one can afford care when one gets sick.
Such modest but cumulative changes — which one of us has called “the heroism of incremental care” — may not occur for everyone and may not happen quickly. But the evidence suggests that they do occur, and that some of these changes will ultimately help tens of thousands of people live longer lives. Conversely, the data suggest that policies that reduce coverage will produce significant harms to health, particularly among people with lower incomes and chronic conditions.
At any rate, whether through a public option (Medicaid) or the Swiss model or single payer, there are many viable options for health care that control costs and are used in virtually every OECD nation. The US is not unique, health care is not more expensive because the country is too big or because Americans are fat or lazy or not virtuous enough to amass enough wealth.
I’ve only ever known one person who might qualify as a 1%er, and if their attitude can be extrapolated to the whole, they simply view taxation by the government as theft - and they are quite sanctimonious about it too. It is a fundamentally selfish worldview.
That’s what governments are (ideally) for, to buffer society against these baser instincts and provide for the welfare of the greater good. But for the past three decades (well, probably longer, going back to the '30s at least), the capitialists and corporatists have been working toward what we have now - a government owned by the wealthiest Americans, with willing participants trapped in their alternate reality bubbles.
I’m tempted to say “horse shit” but, instead, allow me to offer an anecdotal counter point. My step-daughter’s father is literally dying because he does not have health insurance. After an acute case of pancreatitis three years ago, he went into a four month coma from which he miraculously recovered and returned to some semblance of a normal life, albeit without a pancreas. The problem has come over the last three years because, once he was no longer a critical case, the lack of health insurance meant that he could not maintain the level of on-going care necessary to survive without a pancreas. Here in New Hampshire, there are programs that help pay for 75% of one’s prescription drugs but to get a prescription you need a doctor and if you have a doctor you have doctor’s visits and if you have doctor’s visits you have labs and on and on.
So he’s done his best to care for himself but that’s not really a substitute for proper medical care and medication. This Winter he got the flu and he’s been slowly dying since then. Soon he’ll be on hospice and at some point he’ll become critical again and the taxpayers will pay for him to die in a hospital. He’s probably eligible for that level of care now but he knows that if he goes to the hospital he’s never coming out which is kind of a bummer choice to face.
So, yeah, don’t tell me that people without health insurance have it just as good as those who have health insurance. Because that’s some straight up bullshit.
If you don’t have health insurance, you are virtually guaranteed to suffer massive complications. You will not be able to afford to do the things which you need to do to prevent your condition from getting worse.
And that’s assuming you can somehow get insulin without insurance, because of you don’t, you die.
Even with insurance, my Type 1 friend had issues when we changed plans. Her pump, her insulin, things that worked for years and got her through a high risk pregnancy (pretty much all Type 1 are high risk), fell off the formulary for the new plan. She was forced to change something that was working because the cost to stay on it was extraordinary under the new plan.
And the thing is, most people wouldn’t think about that possibility until it happened, nor should they have to. I respect drug companies that pay for research deserve to make a buck, but we have to get drug costs, malpractice costs, and the other costs of medical care under control or we will never fix this. Of course, there are companies spending billions to make sure that never happens…and passing the costs on to us, natch.
I read this study a second time (the first time I actually look at some of the studies it references). Overall, it is long on opinion and short of data to support the hypothesis. But these guys are health professionals and I’m not so let’s accept their conclusion. " the evidence suggests that they do occur, and that some of these changes will ultimately help tens of thousands of people live longer lives."
Now if people on P&R, the media, and social media were saying the Republican bill is going to kill tens of thousand, I’d have kept my mouth shut but the number being talked is it will kill millions. Which is a couple of orders of magnitude larger.
Sure tens of thousand of folks is a lot, but 2,626,418 died in the US last year so we talking about a ~.1% decrease in the death rate once we have health insurance for all. It is seems to me that .1% would qualify as “minimal impact.”
I’m all favor of improving health care for poor people in this country, but Obamacare seems like a really expensive way of doing it. So knowing what you know about the benefits of providing universal health insurance (keeping in mind that Health insurance is different than Health care) how much would be personally willing to spend to make it a reality?
I’m sorry about the guy. My 91 year mom, has wanted to die for the last three years, and its been a painful process to watch.
But, it seems to make some of my points. First, even though he had no health insurance, he did receive health care, which sounded like it was both lifesaving and very expensive 4 months in a coma would be one hell of a hospital bill.
Second if this was three years ago, this after ACA was the law of the land. It seems to me this man is exactly the type of person that Obamacare was to suppose to help. Low income (I assume), with pre-existing conditions. Why didn’t he get an health insurance policy? I believe NH participated in Medicaid expansion. I find it confusing if Obamacare is so wonderful why it didn’t help this guy?
I said having health insurance coverage provides minimal not no benefits. Clearly the group that benefits from having health care insurance is people with a chronic illness. It is certainly easier to be able to go to a fairly wide choice of doctors on an insurance plan than depend on a much smaller pool of free clinics, and public hospital that provide free care. But most people don’t have chronic illness and for those people the primary benefit of health care coverage is lower stress levels,
Ok let’s define average. The average salary and net compensation according the SS department is $46,100. The median age is 38.
If told this person. I’m taking $10,300 out of your paycheck, but if at the end of they year you haven’t been a doctor, or a hospital, or used any medical resource, pretty much the only persons that wouldn’t be back at the end of the year, would be people with chronic illness, or were in severe accidents. I suspect a fair number of folks with chronic illness would suffer for the $10K. This would be true, even I emphasized, "If you do go to the doctor or hospital you have pay them out of your own pocket and it could bankrupt you.
We know this because only 40% of eligible folks enrolled in Obamacare who didn’t qualify for Medicaid. This despite average premium and co-op fair less than $10,300.
It seems to me that most of what @Strollen is arguing is that the ACA is a poor attempt to fix the US healthcare system. This is true! You’ll get no argument from me, and probably most of the folks on this forum. I’ve long said that the only thing worse than the ACA was the system we had before it.
I’ve had to modify that saying, though, because the Republicans have managed to find something worse than both. From what I’m reading about the Senate bill, their version is basically a giant tax cut for the rich that also slowly chokes Medicaid over time and removes financial help for the most needy. It’s worse for everyone except the very wealthy.
What’s really needed is a complete revamp of the system to remove profit incentive (inasmuch as that’s possible) from the care people need to survive with a reasonable quality of life. Much as we as a society provide services like law enforcement and education to everyone (in theory, I know, there’s always room for improvement), health care should be provided. I don’t much care what form that takes, but I do care when I see our elected leaders taking obvious steps away from that ideal. The ACA was and is poorly designed, but it was at least moving in the right direction. What we see coming out of Congress now is a huge step backwards.
Yep. Obamacare is leagues away from being good by any reasonable stretch, but it was modestly better than what we had before. AHCA/BCA is even further away, benefiting a tiny number of the ultra rich while making things monumentally worse for huge swaths of society’s most vulnerable.
@ineffablebob well put, much better than I would have given I am on a phone at the moment.
We absolutely need to change the incentive structure in health care. Right now there are all sorts of perverse incentives that drive up cost while reducing care. Incentives that drive drug research, treatment, and even the way doctors talk to patients. And the profit motive does all sorts of screwy things to these incentives we, as a society, would be good to remove.
No need. There is legal limit to the medical loss ratio. Aggregated medical costs must be at least 80% of aggregated premiums. Therefore, average medical costs are at least 80% of the average premium.
[quote]I’m taking $10,300 out of your paycheck, but if at the end of they year you haven’t been a doctor, or a hospital, or used any medical resource
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That’s the point of insurance. You send checks every year for your auto insurance, home insurance, life insurance, and disability insurance without expecting to get equal value back.
The check you write for health insurance is a lot higher, sure, but that’s because health care is more expensive than, say, repairing your car.
The problem with health care is that the costs are more predictable in the short run than, say, auto repair costs. So it’s natural to want to game the system and only pay in when you expect to use more health care than you pay for. But such a system obviously wouldn’t work for long.
If you think health insurance is a bad deal, consider this thought experiment. Suppose that if you didn’t pay for health insurance one year, then you would lose a year of health coverage, but that year would be randomly determined. So if you didn’t pay this year, some computer would say “Ok, this year you would have been paying for your coverage in 2037, so you will be forced to pay all your own bills that year”. Would you still be so reluctant to write that check? I think most sane people would think twice. But if you think about it, that’s exactly how insurance is supposed to work. You lose money this year so that someone will make you whole in 2037.
Here’s part of the problem with a thorny issue like health care - you’re both right, to some extent.
If you raise premiums, then some people will indeed drop out of the market. Specifically, two groups - those who cannot afford to pay, and those who are young/healthy enough that they feel insurance is a luxury rather than a necessity. The former group is unacceptable for humanitarian reasons, which leads to big public expenses like Medicaid. The latter is unacceptable for economic reasons, leading to the “death spiral” of constantly increasing premiums.
On the other side, there’s an argument to be made that health care is not an optional product. Everyone must purchase it, to some extent, because otherwise you die and/or have unacceptably low quality of life. So it’s a captive market in that sense, because everyone is a consumer. Raising premiums doesn’t somehow force people to no longer need health care, in the same way that higher prices on Coke might force people to drink something else. It might force them into a poor situation where they either die or are financially ruined, but it doesn’t lower the demand. (I see Timex just made this point while I was typing this.)
The way you deal with a market where everyone needs the product is to spread the cost across all of society. This is what we do with law enforcement, and the military, and education. None of those systems is perfect, obviously, but they’re all a damn sight better than what we have with health care in the USA.
If you could pay less for health insurance and keep the same coverage, of course you would. There isn’t any brand loyalty in this market.
So it would be a very bad strategy for an insurance company to maximize its medical losses, because it would lose customers to companies that try to minimize them (by negotiating with providers, drug companies, etc).
An index calculated annually by the Social Security Administration (SSA) based on wages subject to federal income taxes and contributions to deferred compensation plans. The National Average Wage Index (NAWI) is used by the SSA in the indexation of retirement and insurance benefits in the United States
This does not include many benefits. An average American making a salary of 46,000 is very likely to have medical insurance from their employer. You’re talking average american but what you’re really trying to target is average american who is not insured by an empoyer right, and then you kind of need to carve out the medicare group entirely and probably some of the medicaid group and maybe even most the vets. then you need to see what group is left.
You can’t take an average from the entire population and then try and apply it to a fraction of the population (without insurance) and then take a fraction of that population that actually applied for ACA to try and come up with data points. It’s a lot more complicated than that.
For example… if I pay say around 70 x 2 a month for my employer plan, my employer could be paying as much as 10x that, around 600 to 700 at the same time. My benefit is not worth 140 x 12, it’s (140 x 12) + (600 x 12) which is almost 9k, very close to what you;re saying no one gets. Keep in mind, my insurance isn’t great and I am in my industry, that’s typical. And that’s just the cost, no analysis on the benefit itself.
