Obamacare: Better Than Is Not the Same As Good Enough

Five years ago, when very bright people were extolling the virtues of Massachusetts’ Romneycare (the guide to Obama’s ACA), I noted that people wouldn’t be able to afford good healthcare:

Because most humans, as opposed to MIT economists, would think, when it comes to your health, that, let’s say, one out of five adults not being afford health care isn’t all that, erm affordable….

That’s right, households that are in the second fifth take it in the chops (MA has a high median household income). Even if you’re around the median (~$89,000), there’s still a good chance that your healthcare really isn’t affordable.

If this is the standard that is being used for the current healthcare reform legislation, this is both a policy and political disaster in the making. Atrios always points out, people have to like this shit. As I noted two years ago, forcing people to purchase healthcare plans which do not provide them the healthcare they need (which is what the above figures indicate) is not popular–nor should it be (does that even need to be written?).

Sadly, it looks like the Senate bill (and that’s what will pass) is very similar to the MA bill. This is a program that will rightly be perceived as helping the poor at the expense of the lower-middle and middle class (the upper-middle and upper class can take care of themselves). It plays directly into the hands of Republicans, and it does so because Democrats were too concerned with the shibboleth of cost reduction* to pass a plan that would be broadly popular.

Guess what? They still can’t (boldface mine):

Many Americans may believe that private insurance can keep major medical bills at bay. But a new survey finds that one-fifth of people with private plans still spend at least 5 percent of their income on out-of-pocket health care costs.

The findings, from the research group The Commonwealth Fund, found that 21 percent of adults with health coverage spent 5 percent or more of their income on out-of-pocket costs — not including premiums — over the past year, and 13 percent spent 10 percent or more.

“This survey makes it clear that steadily rising health insurance deductibles and out-of-pocket costs are a serious problem for working people, regardless of how they get their coverage,” study lead author Sara Collins, vice president for Health Care Coverage and Access at The Commonwealth Fund, said in a news release from the group…

Many low- and moderate-income adults with high out-of-pocket costs skipped needed care or medications, the survey found. Among those with yearly incomes of less than $22,980, 46 percent skipped needed care at least once due to their health plan’s copayments or coinsurance, 28 percent did not fill a prescription, 28 percent skipped a medical test or follow-up treatment, 30 percent did not see a doctor when they had a health problem, and 24 percent did not see a specialist when their doctor recommended seeing one.

Among people with private insurance who spent at least 5 percent of their income on out-of-pocket health costs, 40 percent said they skipped needed care at least once due to their plan deductibles, 29 percent skipped a medical test or follow-up treatment, 27 percent did not see a doctor for a health problem, 23 percent skipped a preventive care test, and 22 percent did not see a specialist despite their doctor’s advice to do so.

Overall, 13 percent of adults with private health insurance have plans that include a deductible equal to 5 percent or more of their income, including 25 percent of those with low incomes and 20 percent of those with moderate incomes, the study said.

Forty-three percent of adults said their deductibles are somewhat, very difficult, or impossible to afford, including 58 percent of those making less than $11,490 a year, 64 percent of those making $11,490 to $22,980 a year, 49 percent of those making $22,980 to $45,960 a year, and 27 percent of those making more than $45,960 a year.

This was not only predictable, it was predicted. The Massachusetts experience made it absolutely clear what was going to happen: people would get hammered on the co-pays and the deductibles.

I hate being right. Worse, I hate seeing so many smart people get it so wrong, especially when it affects the rest of us.

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9 Responses to Obamacare: Better Than Is Not the Same As Good Enough

  1. Problem is, we’ve been stuck in a false either/or dialogue that won’t allow this to be discussed, and certainly not fixed.

  2. NewEnglandBob says:

    People say they can’t afford health insurance but most have smart phones and monthly charges as well as cable TV and some have nice cars, sometimes two. PlayStation or X boxes also are prevalent and so is $200 sneakers, etc. priorities are screwed up. Food, shelter and clothing should come first. Health should follow.

    • More false either/or scenarios.

      Without cars, internet, phones… it’s hard to keep a job, or even get a job, in most regions like the one I live in. And there are no buses that run within a 1 mile walk to my current job, nor my husband’s job.
      Our cars are paid-off and not new… but they don’t get as good gas mileage as a new Civic does, and need fairly regular repairs. I know many people who have new cars, with decent gas mileage, simply to stay on a warranty and it makes sense for them financially.

      And who can live without a phone these days? These days, even a smart phone plan is not that much more than a landline – which is not nearly as useful… particularly if you’re someone who’s working, and looking for a 2nd job or a better job… ie: not sitting at home by the landline phone. We don’t have smart phones, but it wouldn’t be that much more per month to get them.

      And we don’t have cable tv… but how much could that free up for people who do? $100 per month maybe if they were really splurging on a plan?
      Starting in January, or best most cost effective option for an exchange health ins. plan is $650 per month for us. If we didn’t have enough for that, $120 wouldn’t get us there!

      If health care costs were a few hundred dollars a year, or even a month, then maybe you can say “get a cheaper car” or “shut off the cable tv & sit in the dark at night in silence” or “don’t buy that xbox & sneakers”.

      But it’s ridiculous to think that just shutting off the cable tv & going with a $10 less per month cheaper phone is going to make health care affordable.

    • And cheap shoes… They wear out a lot faster.
      There’s something to be said for good quality sneakers when you don’t drive, and you walk everywhere, like I did when I was in my 20s. That was the one thing I always INVESTED IN — decent shoes & sneakers that would hold up from miles of walking every week.
      And what about people who have jobs where they’re on their feet hours & hours per day. You need to be comfortable to endure that.
      It’s an investment.
      Cheap shoes aren’t so cheap when they fall apart in a month.

      But people who have always driven everywhere in a car & sit on their asses at work all week wouldn’t know a thing about that I’m guessing.

      • NewEnglandBob says:

        Do you listen to yourself? Do you read what you write? There are so many things incorrect in what you say and your attitude on what you want is way beyond what is necessary. You have no clue about what phones cost. It is far costlier than a landline and is costs for each person. The generations under 50 years old have a level of expectation that far exceeds necessity. Until you accept that, there is little hope in reasoning with you.

        • Lol I’m middle aged and I know the prices and what kind of money it takes to have job options. Read about pricing in various areas in various ways before making provincial assumptions about phone costs and transportation. And remember pub transport is not robust everywhere. In pa it’s normal for employers to REQUIRe employees to have their own car. Or at least ask and then choose applicant that does.

        • Mike says:

          NewEnglandBob, you are a putz.

  3. anthrosciguy says:

    Well NEB, one problem is that people don’t like to feel they’re being ripped off. Couple that accurate feeling about American healthcare and insurance with the fact that needing medical care in any given year is not the certainty that food, shelter, transportation, and communication are, and moving medical insurance down the priority list seems rational.

    • I would argue that you can’t even make a proper “priority” list including health insurance. Health care is just that expensive.
      I mean if after paying the basics just to stay alive & keep working, you still can’t afford $650 per month for the health insurance plus all the copays… What gets cut after cable & internet & cell phone? The heat bill? The electric?? The water?????

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