Our health care system is crazy

Probably (I say with no empirical data to back me up)? You’re always going to hear about the most sensational stories from the media (whether they be Canadians waiting six months for an MRI, or Americans saddled with debt forever). My father passed away last year after an eighteen-month battle with brain cancer, and never in those eighteen months, multiple hospital stays, two brain surgeries, and long stretches of chemotherapy and radiation did my family accumulate any debt, or run into medical expenses that were crippling. Most people with serious health problems don’t, but the outliers are the ones whose problems are most visible.

A significant segment of the American populace, though they would not and probably could not articulate it in this fashion, is still very much stuck in the mindset that poverty is a sign of moral failing. So assisting the poor is actually doing them a disservice by preventing their moral improvement. Spice with structural racism and a blossoming oligarchy and you have a very tasty stew for making progress on, well, anything very difficult and often impossible.

But every other first world country has some form of socialized medicine in the first place. Which means that everyone gets some health care along with the spread cost, here In the us there are folks who effectively get little or none.

Well… Maybe half of the US isn’t a first world country?

This is certainly true.

Just checked, this year the ACA plans have gone down to only being 50% higher than non-ACA instead of 100% higher.

So guessing in about 5-7 years they’d be worth it, even if I’d have to pay 350/mo just for myself, assuming I don’t get subsidies somehow.

I really want to know where you get your numbers from Alstein, what wondrous realm you live where insurance costs weren’t already murderously high. From my experience, which is using the Illinois exchange, it costs as much out of pocket for a medium deductible gold PPO plan, or low deductible silver, from the exchange as I am paying for a shitty barely qualifies HMO plan through my work. Both are through the same insurance company ultimately.

So to reiterate I was (and still am until the end of the year) buying my insurance through work. I have a not that good HMO plan. My out of pocket costs are virtually equal (whopee I save $20 a month!) to what it would cost to buy one of the better plans through the ACA exhange. So the 100% higher number? I flat out don’t believe that, or your company was putting a large percentage of your insurance costs in. Which is possible, but in no way reflects the true costs.

My numbers are from the letter I got from BCBSNC , where I was given a quote of 195 for the non-ACA plan. I have a special exemption due to paying for insurance out of my pocket pre-ACA that some states have. Work does not pay my healthcare costs.

The 310 quote for the ACA plan of same benefit comes from healthcare.gov

That’s where I got my numbers.

The first year of the ACA the numbers ended up being 160 and 295.

my grandma has had a stroke and a heart attack over the last couple of years (she’s fine, for a late 80’s lady), which the nhs took care of. No bills needed.

The budget for the nhs is huge, but not that huge that we (the public) would be better off with the american system. The ‘right’ have been pushing hard for that over the last decade, and even New Labour under Tony Blair started that ball rolling. Once your health system isn’t actually about the health of your nations people, you need to stop and think a bit.

I think Alstein also has the issue of being in North Carolina, where (due in part to government shenanigans) there was either no competition on the exchanges or only two carriers offering plans (I may be wrong about that, but that’s my recollection). States with robust competition saw decent pricing.

FWIW, when I was buying individual insurance in the DC area 7 or 8 years ago, my plans were going up in price by an average of 18-20% per year, along with deductibles (over 4 years my deductible went from $200 to $1250). This was for a BlueCross/BlueShield PPO plan. By the time I bailed on individual insurance and got onto my wife’s insurance, I was paying close to $750/mo. for insurance. At the time, I was a healthy nonsmoking male in my early 30s, no pre-existing conditions. The pricing you’re getting seem like a fucking steal to me, and the concept that rates would go any direction but up? Unthinkable!

EDIT: I want to be clear I’m not minimizing your concerns, but holy cow are things different in different parts of the country.

Ok, seems like your arrangement was atypical, even before the ACA. Very few people had a health care plan worth a damn that cost that little pre-ACA. On the individual market it sounds like you were paying on the low end before. Which, hey, good for you. And certainly there are always was going to be cases where an individual could get coverage for cheaper before (though do not discount the fact that as you aged/ had health needs this would rapidly become untrue). Your statement read as if all ACA plans were 100% more expensive than their equivalent before, and that simply is not true. Yours may be, but you were an, unfortunate, edge case.

Not to mention all the other non monetary benefits. I shudder to think of what would have happened pre-ACA this January. Coverage for pre-existing conditions is one of the greatest changes in the entire law, and when my wife lost her work insurance during the third trimester being able to get another insurance plan and not have to worry if delivery would be covered was massive.

I wanted to make this point when Tom’s cancer cost came up but I did not want to sound callous. I thought the American healthcare system is outright cruel. As someone has said, the medical profession is a near monopoly, so to prevent exploitation, even some Chicago school economists can accept some government intervention in healthcare pricing, or having an entirely government funded basic healthcare system like every other first world country. The market solution offered by insurance just sucks, so people either have to suck it up or take their chances without insurance.

If you are in North Carolina as indicated by Aleck, then your exchanges are a sham. The state of North Carolina actively prohibited people from working with the government to understand what is required for minimum plans and in 81 out of 100 counties there is no competition on the exchange; the only choice is Blue Cross and Blue Shield of NC. In the other 19 counties there is a choice of two providers. There is also a premium put on the Exchange costs due to the lack of participation by the state. So when even the basic plans are overstuffed due to ignorance of the rules combined with a lack of competition and the extra premium, the NC (really the Federal) Exchanges are all but useless. That has nothing to do with the ACA and has everything to do with NC politics being played at the expense of the the residents of that state.

Compare that experience with a similar southern state in Kentucky, where the implementation of the ACA has been wildly successful. The sole difference between the two has been that the government of one state worked for the benefit of its residents and the other wanted to play politics no matter the harm done to its taxpayers.

Vermont bails on single payer health care

Not only cruel, plain evil. Estimates (pre Obamacare) say between 20k and 45k Americans die each year because they either didn’t have insurance or because they were poor (hard to dislodge both issues). That’s basically sistemic class cleansing.

Anyway, I lived in the States for 6 years (pre-Obamacare, but with medical insurance). Although I agree insurance companies in the USA have alot of the blame, the whole medical profession is oddly focused on wealth and income, instead of on, you know, actually following the Hippocratic oath. Doctors in the US are, in my opinion, overpayed. Specially since medicine should be a vocational choice, not a choice you make for profit or for a salary.

Although I agree a single payer system for Health care is the obvious solution, that can’t be done without health care professionals having good, but not outrageous, salaries.

Disclosure: both my parent are doctors (here in Spain), so I grew up with a very particular idea of how a doctor should live, and what the focus of medicine should be.

My wife is in rehab now for her hip replacement surgery she had last Wednesday. The biggest hassle isn’t the medical stuff, it’s the insurance. We’re told we’ve reached our deductible on our high-deductible plan, so the surgery and rehab is fully covered–but only until January 1, whether the rehab is done or not. Every little thing, from transport to extra nights because someone didn’t file paperwork at the hospital properly, or whatever, requires more negotiation with the insurer, which makes all the calls. The doctors flat-out told us that they don’t get to decide much; the insurance company makes the calls on nearly everything, based on second-hand info that the hospital sends to their team of mostly nurses who, of course, serve the insurance company’s needs first and foremost. And you never know exactly what is covered and what is not. We’ve done pre-approvals and then had the insurance company claim we never talked to them, even though we have the letter right in front of us authorizing treatment. And talking to the people at the insurance company is a chore, as well. Hold times of an hour or more, multiple transfers, people who have zero idea what they are doing or what anyone else has done. This is true for the hospital system as well; no division or arm of the medical center seems to know what the other divisions are doing, and paperwork submitted once is often required again and again, because no one talks to anyone.

The actual quality of care is quite high, in most cases, but everything around it is a nightmare. And this is with people (us) who are very pro-active, informed, and persistent in contacting the powers that be and following up those contacts. God help anyone who doesn’t have graduate degrees, technical savvy, and the time/resources to harass these jokers constantly.

It’ll never be something that a single state can do. It needs to be covered by a Federal tax which will never happen because the US citizens are so tax-averse.

Give Cindy my best wishes. I hope she recovers fast and fully!

I agree with everything in your post. I’d like to add, though, that it’s partly tied to our educational system. College and Med School are expensive. New doctors often graduate with crushing debt loads. Like healthcare, education is a for-profit enterprise in the US (most institutions are legally described as non-profit, but they act in a way to maximize revenue).

Everything in the US is built around a significant strain of “devil take the hindmost.”

Not only that, they also need (if not working at hospital) to pay for really expensive insurance against malpractice suits. SO yes, it’s at least the interlocking of several fucked up system (education, health care, insurances and the legal system) that make it so that finding a solution without something sort of a revolution is hard (from what I’ve read Obamacare is really a step in the right direction, but still a small one).

The handle of malpractice cases in the US always look very extreme to me. Specially because obviously many suits are not malpractice, just bad luck. Here there really needs to be a strong case for malpractice before the suits can go on. Doctors get sued and sentenced, but it’s not common and it means the go to jail, not that the victim gets rich.