# So who are these people that "can't afford" ACA? **URL:** \ **Category:** Great Debates\ **Created:** [January 14, 2016, 12:09am UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090 "2016-01-14T00:09:22Z")\ **Posts on this page:** 20\ **Page:** 6
**Author:** ![carnivorousplant](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnivorousplant/32/3563_2.png) [@carnivorousplant](https://boards.straightdope.com/u/carnivorousplant)\ **Post date:** [January 15, 2016, 9:24pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/101 "2016-01-15T21:24:45Z")
> [@Boyo\_Jim](#): > > Not that I want to defend a hospital, but you don’t buy aspirin from a pharmacy – you buy it from a retail store, though maybe one that contains a pharmacy. If a pharmacy, even one in a storefront, actually dispensed aspirin by prescription, it would be considerably more expensive both for the record keeping requirements, the dosage verified, and the fact that the number of pills would have to be individually counted. I have a prescription for aspirin, and I have instructions NOT to buy it from the pharmacy, but over the counter. They charge you for everything, including your prescription drugs at a higher price than normal. ---
**Author:** ![carnivorousplant](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnivorousplant/32/3563_2.png) [@carnivorousplant](https://boards.straightdope.com/u/carnivorousplant)\ **Post date:** [January 15, 2016, 9:26pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/102 "2016-01-15T21:26:18Z")
> [@Voyager](#): > > That’s why you can’t bring your own. I’m not disputing that they are relatively expensive, but you also get a nurse to deliver the aspirin and make sure you take it, which runs into money. But she gets paid the same if she is sitting at her station or giving me an aspirin. 🙂 ---
**Author:** ![Boyo\_Jim](https://avatars.discourse-cdn.com/v4/letter/b/87869e/32.png) [@Boyo\_Jim](https://boards.straightdope.com/u/Boyo_Jim)\ **Post date:** [January 15, 2016, 9:30pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/103 "2016-01-15T21:30:08Z")
I’ve driven for 37 years and to date never had to make a claim against my car insurance. You might say that in any particular year your chances to need medical insurance, assuming general good health, are low. Can you say the same for a 37 year stretch? I doubt it. It’s certainly not the case with me. I was hospitalized for 10 days in October. That alone could have bankrupted me. ---
**Author:** ![DrCube](https://avatars.discourse-cdn.com/v4/letter/d/a3d4f5/32.png) [@DrCube](https://boards.straightdope.com/u/DrCube)\ **Post date:** [January 15, 2016, 9:51pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/104 "2016-01-15T21:51:37Z")
> [@Slash1972](#): > > Well, you are only comparing the fees for not having each type of insurance. I would include any costs that arise as a result of not having insurance. As I stated, hundreds of thousands of dollars if you don’t have health insurance and a life-threatening emergency happens. But, as I pointed out before, the average person will pay _more_ in insurance premiums than they will receive in reimbursements. Looking strictly at the financial side, insurance is not a good deal for people who are poor or in decent health. The incentives are against most people buying insurance. The only reason it was common before it became mandatory is that people got it for free as a side benefit from their employer. Sure, the same analysis applies if they could make the choice to opt out of employer coverage and pocket the premiums, but most employers don’t give you that choice. ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [January 15, 2016, 9:59pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/105 "2016-01-15T21:59:14Z")
> [@Slash1972](#): > > Well, you are only comparing the fees for not having each type of insurance. No, I am including the relative risk of occurrence. Do you think getting pulled over or being involved in a vehicle accident happens less frequently than medical incidents that cause massive costs? ---
**Author:** ![UberArchetype](https://avatars.discourse-cdn.com/v4/letter/u/2bfe46/32.png) [@UberArchetype](https://boards.straightdope.com/u/UberArchetype)\ **Post date:** [January 15, 2016, 10:19pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/106 "2016-01-15T22:19:31Z")
> [@Damuri\_Ajashi](#): > > How is paying into a universal health care fund different from paying into an insurance fund? Sure there are some differences but not really enough to justify supporting one and hating the other. “Some” differences? Ya Think? :rolleyes: Insurance premiums and the “not sunk” (for the insurance companies) cost of copays and deductibles goes to the revenue side of the balance sheet. Insurance companies do not by any stretch of the imagination run a “fund.” And unlike most business ventures, the lion’s share of insurance revenue goes to profit, judging by market valuations alone. ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [January 15, 2016, 10:25pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/107 "2016-01-15T22:25:36Z")
> [@UberArchetype](#): > > “Some” differences? Ya Think? :rolleyes: > > Insurance premiums and the “not sunk” (for the insurance companies) cost of copays and deductibles goes to the revenue side of the balance sheet. Insurance companies do not by any stretch of the imagination run a “fund.” And unlike most business ventures,\*\* the lion’s share of insurance revenue goes to profit\*\*, judging by market valuations alone. This (bolded part) is not true. Not by a mile. Not by a light year. ---
**Author:** ![slash2k](https://avatars.discourse-cdn.com/v4/letter/s/439d5e/32.png) [@slash2k](https://boards.straightdope.com/u/slash2k)\ **Post date:** [January 15, 2016, 10:31pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/108 "2016-01-15T22:31:43Z")
> [@Bone](#): > > Combine this with the fact that the penalty for not having health insurance can only be levied against your tax refunds, you could essentially never pay it. No, the penalty for not having health insurance can be death. For example, people who lack health insurance who are involved in a severe automobile accident receive less treatment and are substantially more likely to die than those with private health insurance. ([cite](http://www.mit.edu/~jjdoyle/doyle_insurance_restat.pdf)) A study of breast cancer patients in New Jersey find that the uninsured had a 49% higher mortality rate. (New England Journal of Medicine 329:326-33, 1993). Moreover, it’s quite possible that you won’t even be given the option of running up huge medical bills and declaring bankruptcy. [Cash Before Chemo: Hospitals Get Tough](http://www.wsj.com/articles/SB120934207044648511). “Sure, we’ll be happy to schedule your surgery to remove cancer; just stop by the business office on the way in and give us $50,000 upfront. Oh, you don’t have that much? Well, let us know when you do, and we’ll schedule surgery.” ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [January 15, 2016, 10:59pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/109 "2016-01-15T22:59:05Z")
> [@slash2k](#): > > No, the penalty for not having health insurance can be death. You may have had a point, if I didn’t specifically identify only financial costs in the calculus. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [January 15, 2016, 11:48pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/110 "2016-01-15T23:48:37Z")
> [@carnivorousplant](#): > > But she gets paid the same if she is sitting at her station or giving me an aspirin. 🙂 When I stayed with my father overnight in the hospital, the nurses weren’t doing a lot of sitting. 🙂 ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [January 15, 2016, 11:56pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/111 "2016-01-15T23:56:20Z")
> [@Boyo\_Jim](#): > > I’ve driven for 37 years and to date never had to make a claim against my car insurance. > > You might say that in any particular year your chances to need medical insurance, assuming general good health, are low. Can you say the same for a 37 year stretch? I doubt it. It’s certainly not the case with me. I was hospitalized for 10 days in October. That alone could have bankrupted me. I’ve driven 45 years and made maybe five claims, none major - but I’ve only spent one night in a hospital in my life. So it depends. In both cases, you might have to make claims for things more or less beyond your control. Both forms of insurance are necessary. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [January 16, 2016, 12:19am UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/112 "2016-01-16T00:19:55Z")
> [@carnivorousplant](#): > > I understand they should control the drugs you take, but they charge you much more for them than you pay at the pharmacy. Drugs cost more in the hospital than in the local pharmacy for two reasons: 1. labor - in the hospital each dose is set aside, labeled for the patient, and hand-delivered by a human being as opposed to you going to a pharmacy and picking up your prescription in bulk yourself, transporting it home yourself, and separating the doses yourself. 2. The uninsured - a certain number of patients will simply not pay for their care. The hospital therefore charges everyone more so in the end they’ll have sufficient income to cover costs. ---
**Author:** ![carnivorousplant](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnivorousplant/32/3563_2.png) [@carnivorousplant](https://boards.straightdope.com/u/carnivorousplant)\ **Post date:** [January 16, 2016, 12:30am UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/113 "2016-01-16T00:30:34Z")
I take it, Broomstick, that you do not agree that they are milking the sick and those near death and their insurance companies for every cent they can get? 🙂 ---
**Author:** ![Slash1972](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slash1972/32/6461_2.png) [@Slash1972](https://boards.straightdope.com/u/Slash1972)\ **Post date:** [January 16, 2016, 1:43am UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/114 "2016-01-16T01:43:37Z")
> [@DrCube](#): > > But, as I pointed out before, the average person will pay _more_ in insurance premiums than they will receive in reimbursements. Looking strictly at the financial side, insurance is not a good deal for people who are poor or in decent health. Do you have any figures for this? Seems like the birth and care of the average amount of children would be more than the insurance premiums. > [@](#): > > The incentives are against most people buying insurance. The only reason it was common before it became mandatory is that people got it for free as a side benefit from their employer. Sure, the same analysis applies if they could make the choice to opt out of employer coverage and pocket the premiums, but most employers don’t give you that choice. So, in your view, the amount of people who didn’t have insurance before ACA was no big deal, since most of them didn’t need it anyway? ---
**Author:** ![Slash1972](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slash1972/32/6461_2.png) [@Slash1972](https://boards.straightdope.com/u/Slash1972)\ **Post date:** [January 16, 2016, 1:44am UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/115 "2016-01-16T01:44:37Z")
> [@Bone](#): > > No, I am including the relative risk of occurrence. Do you think getting pulled over or being involved in a vehicle accident happens less frequently than medical incidents that cause massive costs? Do you think bankruptcies because of lack of automobile insurance happened more frequently than bankruptcies because of medical bills? ---
**Author:** ![DrCube](https://avatars.discourse-cdn.com/v4/letter/d/a3d4f5/32.png) [@DrCube](https://boards.straightdope.com/u/DrCube)\ **Post date:** [January 16, 2016, 2:18am UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/116 "2016-01-16T02:18:10Z")
> [@Slash1972](#): > > Do you have any figures for this? Seems like the birth and care of the average amount of children would be more than the insurance premiums. Insurance companies aren’t charities. I hope I don’t need a cite for that. How do you think they make money? By paying out less than what they’re paid, that’s how. > [@Slash1972](#): > > So, in your view, the amount of people who didn’t have insurance before ACA was no big deal, since most of them didn’t need it anyway? Yes. The problem isn’t lack of insurance, its lack of _healthcare_. A $5k/year premium plus a $3000 deductible is just as devastating to a person making $13k/year as a couple of ambulance bills they will also never be able to pay. The problem is that people are poor and can’t afford healthcare. Whether a middleman is involved to help them spread that cost around is irrelevant if they can’t afford it in the first place. ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [January 16, 2016, 2:19am UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/117 "2016-01-16T02:19:48Z")
> [@Slash1972](#): > > Do you think bankruptcies because of lack of automobile insurance happened more frequently than bankruptcies because of medical bills? Do you think you answered my question? ---
**Author:** ![carnivorousplant](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnivorousplant/32/3563_2.png) [@carnivorousplant](https://boards.straightdope.com/u/carnivorousplant)\ **Post date:** [January 16, 2016, 2:26am UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/118 "2016-01-16T02:26:53Z")
> [@DrCube](#): > > Insurance companies aren’t charities. I hope I don’t need a cite for that. How do you think they make money? By paying out less than what they’re paid, that’s how. Exactly. ---
**Author:** ![alphaboi867](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/alphaboi867/32/3898_2.png) [@alphaboi867](https://boards.straightdope.com/u/alphaboi867)\ **Post date:** [January 16, 2016, 3:33am UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/119 "2016-01-16T03:33:21Z")
> [@Damuri\_Ajashi](#): > > AFAICT doctors around here agree to accept only what the insurance pays plus the deductible or copay. Anything beyond that means they are either not really covered by your insurance or the doctor is doing something wrong… When a provider is “in-network” with an insurance company that means they’ve signed a contract with the insurance company to accept their rates, follow there rules about filling claims, getting advance approval for performing certain procedures, etc. A provider who hasn’t signed a contract with an insurance company (aka “out-of-network”) doesn’t have to do any of that. Barring a government regulation to the contrary they free to charge whatever they want, go after the patient anytime they disagree with that the insurance company pays, or make the patient pay for everything up front and sort the claim out with his insurance company on his own. ---
**Author:** ![Slash1972](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slash1972/32/6461_2.png) [@Slash1972](https://boards.straightdope.com/u/Slash1972)\ **Post date:** [January 16, 2016, 4:08am UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/120 "2016-01-16T04:08:11Z")
> [@Bone](#): > > Do you think you answered my question? I don’t know the answer to your question. I’ve been involved in more high cost medical incidents then being pulled over or accidents in my car. Not sure how other people stack up to that. [Previous page](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090.md?page=5) [Next page](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090.md?page=7)