Since there’s a reasonable chance Obamacare will be piled on the ash heap of discarded policy, it’s worth noting the good and the bad. It did two critical things. First, for people with pre-existing conditions, the ACA made it possible for them to get healthcare insurance at a reasonable (or any) price. This was hurting even upper-middle and gentry class families. Second, as a preventive measure against catastrophic healthcare costs, it was effective–it prevented people from having tens of thousands of dollars of medical debt. Again, even upper-middle class and gentry class families have a hard time getting out from under that level of debt.
But as Democrats in Massachusetts noted from the get-go, lower-middle class and middle class families were screwed by Romneycare. Families were being asked to pay thosuands of dollars just to then be allowed to pay thousands more for co-pay and deductibles. This is money these families didn’t have. In Massachusetts in 2015–one of the wealthiest states in the U.S.–one third of households said they did not receive medical treatment because they couldn’t afford it. And Massachusetts isn’t one of the asshole states refusing the Medicare expansion.
One out of three.
Which brings us to this tweetstorm from a doctor in rural Texas. He notes (I’ve cleaned up punctuation etc. for clarity; boldface mine):
Obamacare had kicked in. but I kept seeing [people] coming in far too late, refusing followup care, etc. Why? They had insurance! Obamacare meant that they’d be spared from truly financially disastrous illnesses like cancer. So what was the deal?
Talk to guy [with family] history of esophageal cancer. Guy has severe acid reflux. Recommend endoscopy. He refuses. Why? See his deductible: $5000!
…Answer is obvious: [he] can’t afford [it]. [The] cost just of scoping to diagnose problem: ~$1500. Biopsy, $100. Add a $100 specialist followup, and you still haven’t even touched treatment….
The effect was to transform healthcare from totally unaffordable to totally unaffordable. Most [people] still had impossible barriers to care…
In medical treatment, there’s a ~guideline of the simpler the better. One pill a day, OK. Two pills, not good. Three pills, too difficult. Every single extra step a patient has to take reduces the odds that a patient will/can be treated properly. It’s a big deal.
All this wonk bullshit in Obamacare? I’ve seen grown adults cry [because] they can’t figure out wtf is going on [with] their care. It’s a nightmare. If me, the doc, the nurse, a social worker, the patient, and the insurance [company] can’t figure out what’s going on, maybe your bill sucks. If you need a team of economists, Vox, and two hundred men wearing lanyards to explain how you’re helping the poor, maybe you aren’t….
For the poor, in the case of Obamacare the test came when they went to the doctor for the first time and it was still hellish and unaffordable. Oh, and I can’t tell you whatever happened to the reflux + family history of esophageal cancer guy. Because he never came back.
Yet when Democratic surrogates such as Paul Krugman repeated over and over how amazing Obamacare was–in contradiction to the lived experiences of many Americans–this oddly didn’t rally people.
That doesn’t mean repeal of the ACA won’t be a disaster–it will. But, as we often say on this blog, people have to like this crap–and there were many lower-middle and middle class families who needed better and didn’t like this at all.
If the Democrats ever manage to regain power, they’ll have an opportunity–and the need–to remake healthcare. If they do, please don’t fuck it up again. Make it a system that works.
If the democrats regain political control of the necessary branches of government, they’ll probably still put in something that sucks because their leadership will consist of people who just want a good story to tell for their re-election. They don’t seem able to actually stand up for the working stiffs they claim to represent.
Because *real* universal care is TEH socialismz!
I can only agree that Obamacare is not good enough for the people depending on it.
I can consider myself lucky, that I had salary income until I was laid off in mid-year, said income plus retirement fund withdrawals + unemployment insurance put my family just above the income level to get a premium subsidy. Monthly premium (2 college-age children, spouse) is $965 (for the bronze plan; I am luckily covered by Medicare, 139/month), but daughter had an accident, so indeed we exhausted all deductible limits for her. That means this years medical expenses are something like 25% of income (~$12k premium, ~>$8k various deductibles/copays). Of course, I could have paid ~$1000 MORE premium per month to get the ‘Silver’ plan (2k$ deductible/person), but that would pay only if more of us got sick.–
I recognize that without insurance we’d have been liable for a much larger bill (before rebates, bill for daughter exceeded 32k $, of which ~28k$ was facility charge for 2 hours use of operating/surgery theatre). But I see clearly that for most of us, 8k$ copays on top of 12k$ premium payments would be catastrophic, even with the income at >400% of poverty line (and a smallish tax rebate for medical expenses exceeding 7.5 or 10% of income). Obamacare is still so much worse than insurance I had in the past through a big employer (which also paid 100% of premium from pre-tax income); so I conclude that the presumed market power of the exchanges didn’t work out so well. (And next year’s premium is $100/month more).–
Having not been a user of many medical services before, it was also cumbersome to find out which place would actually accept which Obamacare plan; many hospitals and clinics accept it, but warn that individual doctors may not be in-plan (private insurance has same problem, but is still more widely accepted). The hassle is enormous. America likes bureaucracy.