I was on Obamacare and it kept getting more and more expensive year to year in just three years between 2014 to 2017 it more than doubled in cost for me (single male - age 55-58 - no claims - healthy) and it seemed perched to keep accelerating in cost. The claim is that this is because there was an inherent assumption that younger, healthy people with a tiny real world chance of needing care would sign up to buttress the plans cash flow income and this never happened because it did not make actuarial sense risk-reward-wise for them to sign up.
Even if Trump lost was Obamacare’s actuarial structure going to be sustainable moving forward without ever continuing cost increases?
No. More and more people will move towards having insurance that they can’t use due to narrow networks and high deductibles. More and more people would keep dropping coverage and paying the fine since they figure why pay more than my mortgage on insurance I can’t use even if I need it.
The problem isn’t the ACA, AHCA, medicare, medicaid or any other plan. The solution isn’t single payer (in and of itself). The problem is we spend 2-3x more for health care than other nations.
The US spends about $10,000 per capita on health care annually as of 2017. In Japan they spend $4000. Most wealthy nations spend somewhere in the 4-6k range annually per capita, while the US spends double that.
Also in case anyone wonders, various nations like Australia, Japan, Canada, etc have per capita incomes roughly equal to the US at about 50k a year. So it isn’t a question of national wealth, the US spends 18% of GDP on health care while other western nations spend 8-12% on health care.
Anyway, that is the problem. Single payer will help, but I’ve read single payer will only reduce total medical spending by maybe 10-15%. So instead of spending 10k per capita, we will be spending 8-9k per capita. Is that an improvement? Yes, but the Netherlands has a multi payer system similar to the ACA and it only costs them 5k a year.
So until we get prices under control, the system is not sustainable and it doesn’t matter what system you have. Until then almost nothing about our health system is sustainable and both public and private delivery and insurance systems will be strained and faltering. The problem is neither party wants to get health costs under control because neither party wants to piss off the rich and powerful industries who like the fact that our system costs twice as much, because that means they earn 2x as much revenue. If our health care were as efficient as every other wealthy nation, then that would mean 1.5 trillion in reduced revenue for hospitals, doctors, pharma, medical suppliers, etc. They won’t take that lying down.
It was known that many of the young-and-healthy would reach the conclusion you mentioned and not sign up and that is why there was a mandate and penalty for not doing so. This mandate/penalty was not sufficiently severe, and not enforced, and thus many got away with not paying into the system which reduced the revenue coming in. Reduced actual revenue meant increasing prices, which led to more people not signing on, which reduced revenue, and round and round in a vicious circle.
There’s some truth that Obamacare was not sustainable, but it’s misleading since US healthcare is unsustainable, at least in its current form. Did you think that prices would have stayed flat otherwise?
Healthcare costs have been on an upward trajectory for decades (cite : and note this is costs per capita so no sleight of hand).
Granted the increases at first were to increase coverage, but eventually it was just ever-increasing bloat and waste)
And that was the real problem with the ACA; it did essentially nothing to control health care and pharmaceutical cost growth or make costs transparent to consumers, and the health care and big pharma lobbies have so much influence getting Congress to actually regulate those industries–especially in the current political climate where many apparently believe that “Nobody dies because they don’t have access to health care,”–is virtually impossible. The notion that health care can be treated like other consumer products and commodities is given lie tomwhen consumers can’t even get a straight story on how much a procedure or hospitalization will cost up front and the extent of technical knowledge required to project what treatments may be required or what ancillary costs may be tacked on for CYA tests and procedures, notwithstanding that when you are in the middle of a medical crisis or trauma the last thing you are going to do is make an objective cost versus benefits analysis or shop around for the best price to get your cerebral hemorrhage treated or broken femur set.
The ACA was about the absolute very least that could be done to address the health care shortfall, and even at that it was blockaded at every turn by the Ayn Rand worshipping Tea Fascists who have taken over the GOP and spread fear that if we allow any kind of “socialism” into our health care system it will result in global terror and holocaust. The ACA was always at best a stopgap measure just to see that coverage is available to everyone, which at least keeps the United States ahead of India, but still well behind virtually every other developed nation in terms of comprehensive health care across the population. Cuba–fucking Cuba, an impoverished hermit kingdom run by asshole dictators committing regular human rights violations–has better health care and public health metrics than the United States.
The health care system needs transparency in costs, accountability for misapplying costs or unneeded procedures and tests, and independent oversight to support consumers and assure that health care providers are doing what is best rather than what is most lucrative. And basic medical care, particularly neonatal and preventitive care, needs to be universally available to reduce avoidable health care costs down the road. This is not some kind of Marxist ploy or conspiracy to take over the industry; it is just basic control over a critical area of the economy that has not been shown to be adequately self-regulating and which has the potential to severely impact major segments of the population.
According to Paul Krugman, it was sustainable. Yes, the penalty was too small and there were states where the costs were climbing, but overall it was working. Certainly could be vastly improved. Also if the penalties were not being rigorously enforced, this would make it worse.
Yes, Krugman is a “liberal”, but he is a well-respected economist who is generally right. Unlike the “supply-side” economists who will never admit that their snake oil doesn’t work. See Kansas.
What are the specific reasons that the US healthcare cost per person is 2-3x more than other nations? It appears that the US spend is heavily skewed toward older members of the population. The incidence of deaths from heart disease per 1,000 in the US is no where near the highest country. My only guess is that Americans do more to try and preserve life at the end as opposed to letting life pass on. Family members want doctors to continue to perform lifesaving measures even if the prognosis isn’t good. These types of measures result in much higher medical costs.
Right from the get-go, I could never figure out why the Republicans pretended they were so upset with Obamacare. If I were a Republican, I’d have been absolutely giddy about a plan that forces everyone to purchase a product marketed by the private for-profit sector.
I never got how the old system, where sick people went to the emergency room and if they couldn’t pay, we all picked up the tab for them, was capitalism. But, requiring people to purchase insurance ahead of time to pay their own way, is socialism.
As I recall, there was general agreement among Democrats that Obamacare was not perfect in its original form and that it needed tweaking and tuning up. The main reason Republicans went after it was because it was Obama’s baby, and since they failed to keep him out of the White House–twice–they committed themselves to undoing everything he ever did. And that is still their agenda. I don’t have a specific cite, but surely some here will remember.
Pure partisan hackery. No other reason. Even if you disliked Obama and vote straight ticket Republican, the fact that people like Mitch McConnell–of whom Citizens for Responsiblity and Ethics in Washington has named one of the most corrupt members of Congress–would hold critical issues hostage for the purpose of attacking a political opponent is sickening. Every time he walks out of a committee meeting with that stupid shit-eating grin on his face and giving a thumbs up to the reporters whose actual questions he won’t deign to answer I want to use his head as a speed bag. Plus, his head is the perfect size and shape for it. Tell me you aren’t thinking the same thing now. “One, two, punch, one, two, punch, one, two, punch…”
It’s a good guess but I don’t think it holds up.
Just about every developed nation can find some healthcare metrics where it is among the best and some where it’s among the worst (among developed countries).
If there was an overall pattern of care of the elderly in the US being particularly good we’d be hearing about it a lot. And we also might see it in the life expectancy figures. We see neither of these things.
Also, according to this cite, the US heart disease death rate looks pretty mediocre among wealthy nations. (this is actually a nice site to play about on; you can change cause of death with the drop-down).
Finally don’t forget the death rate for diseases primarily affecting the elderly can be misleading. Something is going to take us down eventually, no matter how good the healthcare system.
Is that a politically sustainable solution? My guess is no. The penalties are incredibly unpopular (because the electorate thinks there’s a free lunch to be had out there).
Mortality is not a good measure of a health system since so much is genetic. For example, black americans and asian americans both use the same healthcare system but there is an 11 year difference in life expectancy.
That’s one reason, which in itself is rooted in issues surrounding rationing generally. But in any case, some drivers of unusually high costs in US healthcare, in no particular order:
Administrative inefficiencies. Lack of standardized billing practices, lack of standardization of medical record formats, relatively poor patient information sharing among the patient’s providers, etc…
Lack of cost transparency
Lack of transparency surrounding effectiveness of various treatments
Profit motives
Lack of care rationing (i.e. provide the treatment, even if practice shows that the treatment has a low probability of success)
The practice of defensive medicine (test ‘just in case’, even if it’s unlikely the patient has a specific ailment)
Lack of power for consumers to negotiate lower prices with providers and drug manufacturers
(Doubtless other drivers that I’m overlooking)
No, US healthcare is likely unsustainable, even under the ACA. Certainly, ACA curbed the overall growth rate of costs, compared to what was experienced in decades prior, but it didn’t eliminate cost growth, neither in per-capita terms nor in %-of-GDP terms.
I supported Obamacare and still support Obamacare, but no it isn’t sustainable. OC is more about getting people covered and not about controlling cost. It is more of a band aid on a system that will eventually collapse on itself. But it is a good compromise until either a single payer system or a more transparent/non-profit system replaces it.
Your OP postulates no GOP attacks. Expand that to providing legislative support to the program equal to other Gov’t programs, i.e. don’t be obstructive and allow bills that fix wording and/or fix parts that aren’t working, and Obamacare would have worked reasonably well. It works in large urban states such as N.Y. and Cal.-to some definition of working. But absent congressional action, the bill is frozen in time and nothing can last if it can’t adapt to changing circumstances.
And they were actively encouraged to disapprove. If there are large groups of people actively badmouthing anything, say taxes, then large numbers of people will start to disapprove. Wait, the Repubs are doing that as well…
The country is is a serious bind. The Republicans have badmouthed the program such that it is considered terrible by many, and have obstructed it to the point that it is terrible to many, and the Democrats are finding that doing the same to the Republicans is great politics. It is going to get worse before something really snaps. Then we will have a reaction even worse that the reaction that got us Trump.
Health insurance is insurance. A process of getting many people to pay a tolerable amount and get few benefits while a few get a lot of benefits. And a process that everyone accepts as “fair”. It is no more or less than that. Any efforts that enhance the toleration and reduces the cost is a plus. Efforts to reduce the toleration and increase the cost makes the process a failure. Regardless of the purpose or the organization running the process.
Cite for them using the same system? Rich people use a very different healthcare system from poor people, and in the US, blacks are much more likely to be poor than Asians.
