>Allen is herself a casualty. While she used to pay $487.50 a month, her new healthcare plan, with reduced coverage, has monthly premiums of $1,967.50.
Brutal.
Meanwhile the White House calls it all "fake news".
Quick summary: the US does not have anything approaching a modern healthcare system. (And likely will not for quite some time due to a set of structural factors.)
Obamacare (the Affordable Care Act or ACA) was an attempt to expand coverage and slow the rate of increase of costs. It did the former but less well with the latter.
One other thing the ACA did is stop the scourge of scam insurers. This is a thing where people would pay for "insurance" and then find out later that their "insurance" did not actually afford them any meaningful coverage. The ACA tried to close a set of loopholes and overall regulate the insurance market more closely.
Anybody reading this from outside the US probably lives in a place where low-cost healthcare is more accessible than it is in the US.
Don’t forget the repeal of the ACA healthcare mandate: “The federal individual mandate of the Affordable Care Act, which required people to pay a tax penalty if they did not have health insurance, was repealed in 2019.”
Aka Republicans being pissy about the ACA (despite having come up with no feasible alternative plan at the time and unanimously voting against it even after it incorporated Republican characteristics) and choosing to try to intentionally financially torpedo it so they could campaign on its failure.
I'm pretty centrist, but the sheer evil of fucking over a country's access to health services for political points is appalling.
Especially since, you know, coming up with an alternative plan was eminently doable -- just not a priority for Republican leadership (then or "we have an idea of a plan" now).
Given that older people tend to be some of the main cost drivers in healthcare, it's sort of silly that we cover them and then refuse to allow younger (cheaper) people to opt in to the same system & perhaps defray costs that way.
You're missing a key piece. Medicare only sort of works because the larger healthcare system has a hidden cross subsidy where commercial health plans reimburse providers at much higher rates. In some cases providers are actually losing money caring for Medicare beneficiaries. We already have a problem with doctors refusing to accept new Medicare patients, and if we moved more patients from commercial insurance to Medicare then that provider shortage would only get worse.
And naturally you make this absolute claim because you've undoubtably lived in more countries than just the United States, right?
As point of reference, I lived in Taiwan for years - they have a national health insurance system, and taxes are comparable if not lower in some situations to the United States.
I have lived in 3 countries with socialized health care system and the public systems were just average to poor, and costing me a lot.
In Germany if you’re mid to high earner, a private insurance can cost you less than half than the public healthcare system and you get much better service. Starting with appointments with specialists, who always give preference to privately insured people.
In this day and age public healthcare system are not efficient and bill the wrong people.
They are mostly payed by young population, between 18 and 65 years old. Specially the highest earners.
However most of the usage comes from 65+ citizens, which are starting to become majority. And also tend to be the ones concentrating the wealth of the country.
These public systems work great when most of the population is young and is paying into the system. But modern western societies are not like that anymore. Wealth is not owned mostly by older people while they barely pay into the system.
Private systems work better because each citizen pays into his old age health coverage during his young years.
> In Germany if you’re mid to high earner, a private insurance can cost you less than half than the public healthcare system and you get much better service. Starting with appointments with specialists, who always give preference to privately insured people.
The solution here is to get rid of private insurance in Germany and only have public. It creates a two class system and private is a terrible choice once you are older, as costs will skyrocket.
Costs when you get older skyrocket, but not your monthly contribution.
You subsidize your own elderly costs by paying slightly more during your younger years. That slightly more is part of the insurance companies Float, which gets invested and is used 30-40 years later to cover your extra costs in old age.
In a public system there’s no float. Everyone pays to cover the costs of the healthcare for that budget year. Which has the consequence that whenever there are population age shifts, the system becomes not sustainable, which is our current situation in Germany.
If everyone (except unemployed) had private health insurance, population age would be non-problem.
So your complaint is that the young subsidize the old in a public system, and your solution is a private system that somehow doesn't raise rates on high risk (older people) and to use the young...to pay for the old?
You also ignore that you can't switch and magically have 30-40 years of float for old people currently receive healthcare, so you have to keep the same system in place until they are gone because insurance companies would instantly go bankrupt under your plan (since they have yet to build a float but have payouts instantly), so now young people subsidize old and have to pay for their non-subsidized future so they will basically have to pay double. Or do you plan just leave old people out of the public system? Pretty nice demographic to just ignore in your plan.
ObamaCare (actually the Affordable Care Act: ACA) is a band-aid solution. It's a way to at least ensure that everyone has a pathway to insurance if they have enough money. Basically, the government negotiates some plans with private insurers and makes them available to the general population.
It's subsidized, but the new budget has drastically decreased these subsidies and so the cost to enroll in the ACA is about to go up for people who want to get insurance through their marketplace.
They stripped it of most meaningful changes to get it passed. What it ended up being was kind of the worst of both worlds. A federally related marketplace for private healthcare insurance. They did however ban coverage limits on “pre-existing conditions”. Before Obamacare an insurer could whine that you had cancer before signing up and refuse to cover your cancer care.
Obamacare failed at reducing costs. It mostly focused on insurance expansion and in consumer protections, not on dealing with hospital, drug, and provider pricing structures that actually drive the spending in the US healthcare system.
The ACA had its most effective cost-control mechanisms stripped by its political opponents. Sen. Lieberman (a turncoat Dem who had campaigned for John McCain) forced the removal of the public option, which would have helped hold prices down through competition. The Supreme Court struck the requirement for states to participate in Medicaid expansion, which limited the benefits for millions in a swath of conservative states. And Republicans in Congress removed the individual mandate, which enabled healthy people to go without coverage, raising prices for everyone else.
It's also important to keep in mind that reforming the US healthcare + insurance system was always going to be an evolutionary, multi-stage process, because of its complexity.
You shouldn't change all the parts in an engine to different specifications at the same time.
The ACA therefore blended structural improvements (insurer admin cost caps, standardized benefits, no prior condition exclusions, guaranteed access, etc.) with lubrication (individual mandate) in an effort to move the whole morass forward.
The worst part about the ACA is that neither party tried to pass ACA Pt 2, that went further. (And yes! That could have been a Republican effort too!)
The previous system was broken. The current system is less broken. It's possible to create an even less broken future system.
The real ridiculousness is anyone campaigning on status quo and/or 'it's impossible to improve things.'
In a constitutional republic like the US, it’s simply too risky to execute major improvements in a big bang fashion. It’s not that different from engaging in a multi-decade software migration project. Sometimes, small changes is really the only path forward.
Part of the reason why Obama, initially a unifying force, eventually became known as a Divider In Chief (in addition to some racial commentary around police work) was that the bold changes of Obamacare left too many victims behind who ended up worse off.
You have to start with the principles of the country and work with them in mind, if you expect to be successful. You also have to assume future change will be dependent on the political winds of the future.
There is likely a lesson somewhere here about introducing “lean healthcare” style of changes instead of “big bang,” but I haven’t taken the time to articulate them.
Maybe starting with principles and making yearly changes that can easily be undone or redone by future administrations is the only path forward.
> Maybe starting with principles and making yearly changes that can easily be undone or redone by future administrations is the only path forward.
I'd trend in the opposite direction. The death of bipartisanship (due to changes in media, education, and gerrymandering: none likely to change soon) render democracies incapable of solving large problems over a multi-voting cycle timespan effectively.
Ergo, the best solution is to punt to an independent body, in the same way central bank management was done.
It makes more sense to have democratically-elected government responsible for and deciding the details, but not the strategic arcs.
Healthcare, national debt / budget deficits, military procurement, voting rights enforcement, education policy would all be better off in consistent hands, even if occasionally less capable ones.
Sometimes, it's more important to keep to an approach than have the optimal approach.
Now? Most democracies get the worst of both worlds there.
The problem, at least in our American mindset, is that since America’s birth, there has been a marked reluctance to have unelected bodies be responsible for anything that impacts the people, ESPECIALLY anything that presumes some globalization intention or some overarching aristocratic ruler (and with good reasons).
Central banking works because problems are instantly catastrophic to the system, whereas healthcare systems are not that fragile. They can survive broken for a long time.
Everybody is okay having a central lender of last resort because the problem is technical, typically unemotional, and in general, benefits every participant equally (because everybody loses is the system collapses).
Healthcare is different in that it affects MY decisions on a regular basis. America is individualistic and self reliant. We never want some government bureaucrat deciding what treatment [I] should or shouldn’t get if [I] can afford it with my own independently earned money. [You] should take care of [Yourself], save your own money, eat healthy, exercise, or not, and live with your consequences.
States have power too. So it does not matter much if some Bernie politician has some fantasy about some central single payer system that has some theoretical average benefit if it restricts ME from making my own choices.
Other countries have other cultures and foundational principles, so Bernie may have better luck there.
But not here.
Is it limiting? Probably for this case. But the fact is the system works for many other things. Everyone wants to come here. It’s the best country in the world etc etc. It does not have to be perfect. But it’s the best we get with the philosophy that made the country what it is.
Does it suck for healthcare? Overall, probably. But not for [ME].
We saw the system has limitations in other cases (think pandemics etc, but even now, many Americans can’t forgive the politicians that kept them imprisoned in their own homes).
You have a right to life, liberty, and pursuit of happiness. But not to anything that must be provided by someone else, like healthcare.
The Supreme Court is not “a political opponent.” It’s literally the way the country works. It found the requirements for states to participate to be unconstitutional. In fact, it was also SCOTUS who eventually determined in 2012 that the individual mandate penalty was functioning as a tax for constitutional purposes. This was the basis for upholding the law. The mandate itself was not upheld under the Commerce Clause but survived because the financial penalty was deemed a tax.
> The ACA had its most effective cost-control mechanisms stripped by its political opponents.
Because of lobbyism, healthcare sector is extremely strong politically and don't want to reduce their income, Democrats aren't immune to that they have mostly been just as pro corporate as the republicans are they just are pro different corporates.
Unfortunately not. It's still very broken, and next year it will be worse for a ton of people. I got AI to write a short answer for you:
> Short version: Obamacare never turned into “free primary care for everyone,” it was just a bunch of rules and subsidies bolted onto the same old private-insurance maze. It helped at the margins (more people covered, protections for pre-existing conditions), but premiums/deductibles can still go nuclear if you’re in the wrong income bracket, state, or employer situation. From an EU/Poland perspective it’s not a public health system at all, just a slightly nerfed market where you still get to roll the dice every year.
You comment sounds like snark but I understand if you don't know what Obamacare is.
(And I'm not an expert so hopefully people will correct any mistakes)
"Obamacare" was never healthcare for all. It is a GOP healthcare plan that heavily subsidizes private insurance. (Because free markets) And the current affordability crisis is the result of letting the government subsidies that help people pay for their Obamacare coverage lapse.
On a positive note: Obamacare (aka the ACA-PPP) did put some restrictions reasonable restrictions on the terrible things insurance companies used to do. For example, drop customers for "pre-existing conditions", impose lifetime payout maximums, etc.
Qft. Many of the provisions in ACA are direct GOP asks from the bipartisan negotiations around it... before the party decided to unanimously vote against it at the 11th hour.
> the previous administration thought everyone should be "temporarily" paying for her plan. Moving money from person A to person B obviously doesn't make anything cheaper
No, but it means I can't pay for a first-class ticket while someone else survives. I'll take that deal.
I support subsidies to help low-income citizens who legitimately can't afford health insurance, but some of the temporary ACA subsidies passed in 2021 were ridiculous. They were handing out cash to early retirees as young as age 55 with incomes over 400% of the poverty line.
I don't want my tax dollars wasted on subsidizing them. Give the money to someone who actually needs it.
(Of course the real problem is healthcare costs accelerating out of control. Insurance subsidies won't fix that problem. In fact they make it worse by encouraging healthcare providers and drug companies to raise prices even faster.)
If we start to think about who "actually needs" things, we need to question whether any of the very wealthy "actually need" their wealth. I would be fine with seizing all of anyone's income (including unrealized capital gains) in excess of, say, $20 million just to give everyone else some cute stickers and lollipops. The giant flow of wealth to those at the top is a far greater misallocation than any amount towards the healthcare of anyone not at the top.
> some of the temporary ACA subsidies passed in 2021 were ridiculous. They were handing out cash to early retirees as young as age 55 with incomes over 400% of the poverty line
These are legitimate complaints. Trashing the system because it's overly generous in some respects is insane.
Income isn't wealth. Someone making $62,000/yr in income without working at 55 (i.e. no Social Security) is likely comfortable. That's >$1m in invested assets plus whatever is owed to them as retirement income when they reach retirement age. It's especially unclear if everyone else's payroll taxes should be spent allowing this person to retire a few years earlier.
This is all before including the other large personal expense (housing) for this person is likely imputed rents from homeownership which aren't counted as income but function that way.
Surely you are capable of thinking there are tradeoffs here where one can set a level without dealing in absolutes. Put differently why not expand Medicaid to cover every American regardless of income? 400% is just as arbitrary as 1000000%.
I do actually think that universal healthcare is the best policy. But that will mean some wealthy people get coverage paid for by the state, which aggravates some people.
A substantial amount of discussion in early retirement communities is about how to stay below 400% AGI, which is why I found it odd to see a criticism of healthcare subsidies going to early retirees in the context of the expanded subsidies.
Great then you have even bigger problems to wrestle with regarding solvency. Americans won't choose cost effective treatments, and if you force them to pay out of pocket for experimental therapy you will be accused of running death panels. Good luck with that. On top of all that, they are also unhealthy due to a variety of lifestyle factors including that their primary mode of transportation likes maiming them.
I’m one of those retirees. It’s OK. I was prepared for this, and can afford it, but a hell of a lot of others on a fixed income, are totally screwed.
> Give the money to someone who actually needs it.
Like billionaires. They are the ones that really need it, and they get it; every time. Those yachts don’t pay for themselves.
If anyone thinks poors will be getting any help, they are fooling themselves. Helping poor people is quite unpopular, in the US (where they conveniently forget that most of them are born in the US white, but politicians make it seem as if they are all dark-skinned immigrants). Many of the hardest-hit states will be ones that enthusiastically voted for this.
GP is saying that they’re okay giving up buying first-class tickets if it means someone else gets to live. (Because they pay more for health insurance, which allows someone else to pay less.)
It’s relevant because while the comment says that “they’re okay giving up buying first-class tickets” what they really imply is that they want everyone to give up buying first class tickets.
If they want to constrain their own choices to help a nameless “someone,” they can literally do that themselves without involving the taxpayer at large. Just send the check to HHS or to a specific charity or individual.
As a supporter of single payer(or really, anything else), I support this move. When half the nation is on subsidized healthcare they aren't so likely to care about costs.
Now, you have a lot more angry people, and hopefully that leads to real reform, because what we have now is unsustainable, even to upper middle class families.
HMO laws allowed for-profit healthcare insurance. Groups of doctors banded together and carved out exclusive contracts to sets of hospitals and providers.
Before this I recall seeing $7 taken out of my paycheck and there were no deductibles or copays. Meds were $5.
The govt also acts as a monopsony and forces lower prices. Same effect [0] different mechanism.
[0] actually a better effect - the govt actually does force lower prices, whereas competition is subject to all sorts of other effects where it doesn't actually function to lower prices.
Bronze plans with $5-6k deductibles have always ran more than what people paid for rent. Healthcare is the one thing that's outpaced inflation in higher education.
Very good unsubsidized health insurance wasn’t anywhere close to 2k/month inflation adjusted the last time I used COBRA to continue my employer’s insurance after getting laid off.
The underlying issue is inflation adjusted healthcare related spending increased 6x per person since 1970. Some of that is an increase in quality, but middleman are a huge factor.
So first you say it has always cost this much, but in the next breath you say that its cost has outpaced a high rate of inflation. Mathematically, these can't both be true.
Brutal.
Meanwhile the White House calls it all "fake news".