As I’ve mentioned many times before, Obamacare is a signficant improvement for many people–the massive numbers of visits to healthcare.gov in the first day are a testament to that. But the weakness has always been the deductibles and co-payments that are going to cause people to get sick because they avoid medical treatment–and Obamacare does nothing to fix that. Former ScienceBlogling Peter Lipson and GP (boldface mine):

While everyone has been busy losing their minds about Obamacare, people are missing the less visible revolution in American healthcare. This quiet revolution started years ago, and the basics are very simple: shift costs away from insurers and place them in the hands of doctors and patients.

For patients (at least, the ones with insurance) this has meant a dramatic shift toward cost sharing as employers purchase less-unaffordable health plans. These plans, with their Byzantine system of moving more costs to providers and patients, are understood by no one except their creators…

The kind way to describe this is increasing patients’ “moral hazard” by giving them a personal stake in their health care costs. What I actually see in my office is people putting off necessary care for fear of large bills. (This seems to happen whether or not the service is actually “covered”. Most people I see don’t understand their insurance well enough and simply act in a way to avoid potential bills.)

I told you this would happen. Elisabeth Rosenthal also describes this shift (boldface mine):

“More of the cost responsibility is being shifted to patients, and more to patients with serious chronic illness,” Mr. Mendelson said, noting that the silver plans, the second cheapest, are intended to cover only about 70 percent of a patient’s medical costs. “This is different from the concept of insurance we’ve been carrying around for a long time. So people who sign up for insurance thinking all will be covered are in for some surprises.”

… “The premium prices are reasonable — for some people we’re talking about as much as my cable bill,” she said. “Yes, there are high co-pays, but there’s also a cap,” she added. “We now have people come to us owing $50,000 or $150,000. So if the worst-case scenario is you pay $5,500, you won’t go bankrupt over that.”

But as Lipson noted above, a lot of people won’t get the care they need either:

A healthy 60-year-old in California with a chronic condition like asthma who needs little more than asthma medicine and an outpatient hernia operation could easily pay $7,000 in premiums plus a $2,250 deductible plus $3,000 for the 20 percent hospital co-pay. When my husband recently developed a blood clot in his leg after a bicycling injury, the generic heparin shots to treat the condition cost $1,400 at the pharmacy. Though the medicine is nothing new, our insurer considered it a specialty drug because of its price. Under some states’ silver plans, that would require a 50 percent, or $700, co-pay before getting this potentially lifesaving treatment.

I discussed some people’s unusual definition of ‘affordable’ three goddamn years ago–and nothing has changed.

Is this better than nothing? Yes. Is it good enough? No. As we say around these parts, people have to like this crap. With these additional payments, I’m not sure they will.