Tuesday, May 09, 2017

HEALTHCARE USA: a guide to "Obamacare" (the Affordable Care Act)

Sackerson has asked me to write a short piece on the effects of the Affordable Care Act, based on my 39 years of fighting insurance companies in the US.

Since this is primarily for readers in the UK, it helps to understand that many Americans do not consider healthcare to be a right, or even an issue of infrastructure. The fact that it is referred to as the 'healthcare industry' should show that the emphasis is on the money.

There are many different programs for it, including:
·         Veteran's Administration – a completely separate set of doctors, hospitals and testing facilities, paid through the Defense budget, only for those who have served in the Armed Forces. In the past two decades, its funding has been reduced by conservatives. The inevitable problems which have arisen during two wars have been used as justification that the system should be privatized.
·         Medicare – a federal program for the elderly and disabled, paid by payroll taxes. Ever since it was introduced by President Johnson in his Great Society initiative, it has been another target of conservatives.
·         Medicaid – for the poor, paid by a mixture of state funds and payroll taxes. Also introduced in the Great Society and yet another target for anti-government conservatives.
·         Group insurance through employers – lose your job, lose your coverage. Only available if you work enough hours.
·         Group insurance through unions – rapidly going away as the unions do.
·         Group insurance through small business co-ops – typically expensive.
·         Personal purchase – very expensive.
Most of these offer multiple plans, requiring specific doctors and hospitals (or a hefty financial penalty),with assorted co-pays, lifetime maximum benefits and deductibles. I have three degrees in Mathematics, and I still cannot figure out what procedures other than basic office visits will cost, as the bills dribble in, sometimes for a whole year.

That said, here are some of the changes that have taken place:

More people covered
Before: An estimated 31 million or more uninsured.
After: Over 20 million people with affordable insurance.

Insurers' profits capped
Before: Insurance companies kept up to 54% of all premiums.
After: Insurance companies restricted to 20% of premiums.

Fewer health-related bankruptcies
Before: Medical bills were the #1 reason for bankruptcy.
After: Medical bankruptcies down 90% or more.

Less misuse of emergency services
Before: People without coverage used Emergency Rooms for primary care, paid by increased hospital costs for everyone else. Hospitals are required by law to treat critical patients.
After: Much less pressure and cost for many of those hospitals. Better outcomes for those with chronic conditions.

Extended coverage for dependent children
Before: Dependent children age 18+ not in college, or 22+ in college lost coverage on their parents' policies.
After: Coverage for dependent children up to age 26.

Birth control
Before: Many policies did not cover any birth control, although most covered viagra.
After: All policies cover birth control.

Cover for pre-existing conditions
Before: People with pre-existing conditions, from arthritis to cancer and much more, could either be refused coverage for those conditions, refused any coverage, or made to pay for much higher risk and higher cost policies.
After: Pre-existing conditions covered with no penalty.

Benefit caps removed
Before: Most systems had a lifetime maximum benefit, typically around $1 million, which could be exhausted in a couple of months of intensive care.
After: No lifetime maximum.

DRAWBACK: unintended effect on work contracts
Before: Small companies (around 50 people) could offer as many hours to their workers as they wished without offering benefits.
After: Part-time workers with over 30 hours per week must be offered coverage, so many people had their hours cut back.


Paddington said...

Example for the week: I went to a cardiologist recently, and paid my $35 deductible. After the insurance company paid what they determined was 'fair', I received a bill for another $215 yesterday. This was a brief EKG and a short consultation.

James Higham said...

Most interesting read, thank you.

Sackerson said...

JD passes on this link, to a book on the scale of medically-caused illnesses, injuries and deaths:


Paddington said...

More crap. While there are mistakes, modern health care does more to prolong and improve quality of life than anything except better food and sewerage systems. While that book cites 800,000 per year, a recent misquoted article gives 350,000, and that figure turned out to be too big, by an order of magnitude. There are just too many sad cases of people denying that medicine works, and moving to woo instead.

Sackerson said...

The BMJ puts iatrogenic deaths in admittedly not the first, but the third place: