Health care in the USA

[Geo]

With president [Sleezebag]'s latest struggle with legislative power in mind, I started wondering.

How many of the forum's members here (people living in the US of course) have been benefiting of Obama's Affordable Care Act installed a couple years ago?
And would you've been likely to lose this ACC entitlement if [Sleezebag]'s proposal would have been voted in last night?

[Rusty Edge]

Yeah, I think so, on both questions, but it's complicated, and my situation is atypical.

I think I have benefited from the standpoint of saving money, overall, and not just due to forced lapses in coverage.

I think I would have had to find a new insurance provider had their been a change, simply because our experience with ACA has been a procession of insurance company changes and lapses, and the implementation of ACA abolished the type of high deductible catastrophic care policy we'd been happily using before that. So repealing ACA wouldn't instantly re-create the policy choices we had before.

My medical history includes spontaneously collapsed lungs, cough syncope, Meniere's disease, and parathyroid gland problems, and kidney stones. I'm not 60 yet. A combination of bad luck and bad genes.  I'm one of those "interesting" patients. While my wife's issues are more pedestrian, she'd not a patient companies are eager to insure, either. We've been in and out of high risk pools, state and federally sponsored insurance since ACA took effect. No, I didn't get to keep my insurance or my doctor as Obama promised, even though I was pleased with them.

I think there are a number of better approaches to healthcare than the ACA. I think the one just voted down was only better for high income people and insurance companies, and even more poorly devised, and presumably would have been worse on implementation than ACA. A worse idea.

I'm probably the wrong guy to ask. In short, I paid insurance all of my life even when I didn't need it, and was short on cash and had to chose between insurance and utillities, was happy with my healthcare before ACA, and didn't need anybody to "fix it".

[gwillybj]

I don't think the ACA affected my household's coverage, since it was all in place before.
I don't mind sharing how it works for us:

I receive SSD (Social Security Disability) due to physical and psychiatric issues. This allows me to use Medicare, the federally-run program.

My girlfriend receives SSI (Supplemental Security Income), also due to physical and psychiatric issues. This allows her and her two sons to use Medicaid, the state-run program.

Since the Republican plan was supposed to not touch Medicare and Medcaid (I don't know if this is how is was actually written), we should have been okay.

[Geo]

If I understand correctly, quite a number of medical insurance programs are at large in your country.
Must be quite a hassle to determine which one suits your needs best (at least, if you have a choice. You didn't seem to have that, Rusty).

Are so many people in the US diagnosed with some condition or the other? Both of you have issues, and for another one I know the same counts.

[Unorthodox]

Hard to tell how much was caused by "Obamacare" and how much from market influences but we've seen generally declining coverage over the last few years.  Don't think the new bill would have impacted us at all.

[Unorthodox]

If I understand correctly, quite a number of medical insurance programs are at large in your country.
Must be quite a hassle to determine which one suits your needs best (at least, if you have a choice. You didn't seem to have that, Rusty).

Are so many people in the US diagnosed with some condition or the other? Both of you have issues, and for another one I know the same counts.

Generally. Full time employed people have 2-3 options their work helps pay for.  Retired, disabled, and some welfare folks get Medicare/Medicaid.   It's when you move outside of that bubble it gets interesting.

Dor instance, my brothers are both self employed. One with a small business. They have issues with the health care system.

[Rusty Edge]

Yes, it's true that I don't have a lot of insurance choices, and none of them seem to be long term choices due to companies getting out of health insurance, and changing government eligibility criteria.

I think Uno is right about the health insurance situation in general.

There's a further wrinkle. Here in Wisconsin, the state didn't implement the Medicaid expansion and insurance exchanges the way Obama envisioned. Obama blames my governor for political posturing because he had presidential ambitions. Gov. Walker said the Affordable Care Act  was a bait and switch scheme. Actually, I think they were both right. Gov Walker did run for president. While the average health insurance premium increase in Wisconsin is 16% this year, in our  sister state of Minnesota ( who did embrace the ACA insurance exchanges and Medicaid expansion, and accepted all of the federal subsidies ) the average premium increases were between FIFTY and SIXTYSEVEN %!  The state of Minnesota had to come up with over 300 million dollars in subsidies this year alone , to prevent a collapse. Large numbers of people were preparing to drop their insurance and pay penalties for not having it.

So me and my wife being high risk and in the early retirement category, and in one of the few states that did things it's own way,( within limits )  my anecdotal experience probably distorts the big picture.

[Geo]

Rusty, wait one. People need to pay penalties for not signing in a health insurance contract?

And about that price increase in Minnesota, were  those for people enrolling in ACA, or for those who stayed outside of it?


What you write UnO sounds more or less like it is in my country. Working in the private sector you're covered through your employer with your wage being paid for a time if something happens, at least on the workfloor and during commuting from and to work. Working self-employed, you don't have an income at all during your sick leave.

[Rusty Edge]

Rusty, wait one. People need to pay penalties for not signing in a health insurance contract?

And about that price increase in Minnesota, were  those for people enrolling in ACA, or for those who stayed outside of it?

1) Yes. A feature of ACA was that health insurance was mandatory for all. Rather than jail time, the penalties are financial.

2) Enrolling in. Buying insurance on the state exchange.

So now you know why there were a lot of people who wanted changes made to the existing law. Broad participation was supposed to drive costs down, but it hasn't.

[Geo]

In conclusion, it is thus another system next to the already existing ones, but pointed towards those the traditional providers weren't willing to cover.

Seen from that perspective, one universal 'base' system does seem better.

[Lorizael]

When I quit my cushy government job in 2015, I lost insurance and had to sign up for the ACA. Since then, I've had 0, 1, and 2 jobs at any given time, none of which have provided insurance because they're part-time, and none of which pay me all that much. The result is that I qualify for Medicaid, which means my healthcare is overseen by a Managed Care Organization of my choice and doesn't cost me anything (as long as I get care from a provider in the MCO). I hadn't bothered to make use of this at all until recently, when I tried to get an eye exam and then 3 weeks ago when I had my trip to the ER. So far it's been a bit of a hassle to use, but I have low tolerance for bureaucratic headaches. Oh, also, Maryland's healthcare website is terrible.

Since I think I only qualify for Medicaid because of the ACA Medicaid expansion, I'm assuming I would have lost coverage had ACA been repealed. That would have been bad.

[Rusty Edge]

In conclusion, it is thus another system next to the already existing ones, but pointed towards those the traditional providers weren't willing to cover.

Seen from that perspective, one universal 'base' system does seem better.

Yes it's sort of like our tax code, cobbled together and layered over time, with no consistent philosophy. I would agree that a universal system like Medicare for all, or Canada's system would be an overall improvement. Coverage for more people for a lower % of the national Gross Domestic Product, with lower infant mortality and greater longevity.  I don't know if its the best way, but its better than what we've got.

*****

There are other factors. Many drugs and vaccines are invented, tested and developed here. The regulations are strict and the costs are high, to prove that new drugs and vaccines are safe and effective. When those things are sold here, the pricing has all of those costs built in. The companies negotiate lower prices with other countries, even Canada.

Then there is the matter of lawsuits and malpractice insurance, which seems to be more of an issue here than anywhere else in the world.

Another issue is population distribution. Rural people are less cost effective to serve. You may think, 'well, what about Canada?', but 90 % of Canadians live within 90 miles of the USA. Likewise, I think most of the Aussies live close to the coasts. Those concentrations make people easier to provide with healthcare and internet than America's farmers.

****

There are other ways of doing things. Food is an example. We have all kinds of meats, fruits, produce, and processed foods. A better selection and quality than I've seen in the countries I've been to. Plenty of competition , too, so that if you don't like the quality, price, or purity, you have alternatives.  The poor people get a monthly allowance from the government on a special debit card which is only good for unprepared food and drink. They can spend it where and how they see fit. It seems to work well.

Before we had ACA I looked into various healthcare solutions. I was impressed by the approach taken by Oregon and some other states I don't remember. Their philosophy was that while healthcare was not a right, it was an essential service, and they treated it like water, gas, electricity and telephone. It was regulated by their Public Utility Commission, which could veto unnecessary or excessive price increases.

Two reforms I'd dearly like to see in American heath care are published pricing and 30 day or free billing. It shouldn't be that hard to do in the computer era, but nobody knows what anything costs until after the fact. Sometimes 5 months after! By then who can remember well enough to dispute erroneous charges?

[gwillybj]

Two reforms I'd dearly like to see in American heath care are published pricing and 30 day or free billing. It shouldn't be that hard to do in the computer era, but nobody knows what anything costs until after the fact. Sometimes 5 months after! By then who can remember well enough to dispute erroneous charges?

[Yitzi]

I benefitted from the ACA for about a year, I think...then I became eligible for Medicaid, and hence ineligible for the ACA (even though the doctor I was using the ACA-provided insurance for doesn't take Medicaid).

[Buster's Uncle]

I just got back from an SSI hearing, and boy are my arms humiliated.