My opinion is that this is looking at the issue from the wrong direction.
First here are my high level beliefs.
- No person, regardless of class, should be put in financial ruin because of a medical emergency. While some can be prevented many of them cannot.
- We as a society benefit from everyone being as healthy as possible. I don’t even mean morally but economically and productivity wise.
- We as a society benefit from people being as low stress as possible (again, for economic and productivity reasons).
- Preventative care is important. I don’t just mean physicals but it’s important that when someone feels something bad going on they are not stressed out trying to weight the financial vs trying to get adequate care before it turns into an issue that requires an ER.
I mention these because trying to frame the issue with a single dimension that healthcare costs are too out of whack is not seeing the full picture. It is not feasible to have health care costs low enough that major emergencies can be paid off without causing major financial hardship for the majority of the people. We still need insurance to assist with those situations and in order for any insurance system to work the risk pool needs to be as wide as possible.
My boss from a few jobs ago was perfectly healthy in his low 20s when one day he was in major pain. His appendix burst and he had to be taken to the hospital and undergo surgery to have his appendix removed. Since he was healthy he figured he didn’t need insurance and now has debt he figures will take him 30-40 years to pay off, and that comes right out of any disposable income that he might otherwise be injecting into the economy (and has it hanging over his head). He’ll have his masters paid off before that.
Contrast that to my mother in law who tripped on an extension cord and split her kneecap into 3 pieces. She had a Centricare visit with x-rays and whatnot. She then had surgery consultation, actual surgery, and months of rehab to get things flexible enough to at least be able to walk again. The difference is she had insurance so they paid about $5k total and the rest was covered. While that can be a lot for a good number of Americans it’s not astronomical.
Both example are things that are are not going to be financially manageable by most Americans no matter how efficient you get health care prices. Even in countries like Mexico where people take medical vacations to get lower healthcare, it’s still not pocket change and the prices are only like that because their general economy is so much worse than ours (not saying this is the sole reason).
So no matter what we still need insurance, and in order for insurance to be viable the risk pool needs to be as wide as possible. The problem with the ACA that I see is two fold:
- The individual markets have very small pools filled with people who are either part time, self employed or employed by very small employers that are not required to provide coverage.
- A lot of people who did not have coverage before now have coverage.
The first issue is that the risk pool is now split up a lot more and it’s hard to get wide enough coverage to keep everyone’s premiums down. This is compounded by the second issue which isn’t just about sick people getting coverage but now someone who didn’t seek out care for a migraine or a hurt ankle because of the out of pocket cost can now go to a outpatient care center to have it looked out with the finances being somewhat manageable.
For instance I really badly hurt my ankle playing soccer and the next day I could barely move it or put pressure on it without it hurting. Even with the salary I take in (at the time I was making $95k plus I think my wife was working at that timie, and this is in Florida where the cost of living is low) I hesitated to go to a doctor to get it looked at because even though it might have been broken it might not have, but I didn’t want to pay a $75 copay just to be told it’s sprained and stay off it. I did end up going in due to the pain and it turns out it wasn’t broken. They did give me a good brace that allowed me to walk on it so I guess it was a net win but it was also a non-insignificant cost. However in the end it was worth it because if it was broken I could have done some permanent damage by trying to walk on it instead of letting it mend properly.
This is where lower healthcare costs can help. In fact I believe that health care costs should be lower so that we can get rid of insurance deductibles since those are the biggest scams ever (Higher deductible = lower premium, but in order to be able tot cover those deductibles you need to be in a higher income class).
Those instances are what will benefit from lower health care costs.
This is mostly a long way of saying that this isn’t a zero sum game and there’s no one solution to it. We need both. Healthcare costs need to come down so people are not afraid to go to the doctor when they have the flu, or their ear is hurting differently then usual, or a limb might possibly be broken. Getting those people healthy again without them worrying about how it’s going to hurt them financially will allow them to return to full productivity sooner. However we still need insurance for catastrophic and emergency issues and for that the ACA is helping.
I’m not going to sit here and say that ACA is perfect but it’s a step in the right direction. Yes it has flaws but it’s also allowing a lot of people to get healthcare they need that they couldn’t get before, and imo that’s a good thing for society. It does not mean we are done and there’s not more work to do, and it does not mean that we can’t still tackle healthcare prices (though that’s going to be very difficult with healthcare being for-profit plus the out of network scams going on with insurance companies and health care providers). We just need the political will to keep trudging forward, but that seems very unlikely in our political atmosphere (for the same reason we will never see single payer).
