As I read this article at The Mercury News in the rise of high deductible healthcare insurance programs:
Double-digit premium hikes are jolting millions of Americans who get their coverage through the Affordable Care Act, but just the opposite is happening to Ryan Lemburg.
Like most Americans who get their health insurance through their employers, the Tracy school teacher has seen his annual premiums creep up at a historically low pace since the country’s controversial health care law, Obamacare, was passed six years ago.
Good news, right? So why doesn’t it feel that way? Behind that stability in premiums for many of the country’s 150 million workers is a trade-off: they’re being shifted to high-deductible health plans, which companies are increasingly championing as a way to hold down their own health care costs. While employees may see less coming out of their paychecks, they’re on the hook for more out-of-pocket costs before their insurance coverage kicks in.
I tried to relate that to the experience with the insurance plans offered in the exchanges under the Affordable Care Act. Trends in both seem to be towards plans with punishingly high deductibles. It reminded me of a description I heard long ago about Social Security to the effect that in the Social Security system a regressive tax and retirement benefits that are too small come together to become the third rail of American politics.
What end game is envisioned for healthcare insurance, whether private or offered under the auspices of the PPACA? Increasingly, it looks as though my description of the PPACA given way back in 2009 that it would become Medicaid for all appears to be correct.
Is it a fully-socialized system like British National Health? An end of healthcare insurance? Catastrophic care plans only? I think that many of the ardent supporters of the PPACA envisioned it as the first step in the road to a single-payer system but a single-payer system for what? To my eye what we’re moving towards does not seem to be a system worth having.
I’d add that in this day and age a disturbing number of people don’t seem to understand the relationship between insurance/coverage prices and the actual costs of providing healthcare.
My complaint, whether about the PPACA or healthcare more generally, has consistently been cost rather than price. IMO healthcare is at least 30% more expensive than it would be in the absence of Medicare/Medicaid and that’s borne out by the experience in other OECD countries.
And if you go back to my old posts on the subject you’ll see that my greatest complaint about the PPACA was that, not only did it not do enough to address excessive costs, it made it politically harder to address them down the line.
I’ve mostly worked as a non-benefited contract worker, but if forced against my will into insurance, I would gladly accept a 100% deductible, 100% co-pay policy with a premium of $0, as long as such were reflected in a commensurate pay increase.
The cost of medical care in this country is doubled by regulations.
“IMO healthcare is at least 30% more expensive than it would be in the absence of Medicare/Medicaid and that’s borne out by the experience in other OECD countries.”
??? Medicare charges about what other OECD countries charge. Medicaid a bit less. I suppose we would be spending less on health care absent those two, given that many would then have no health care coverage.
Steve
Per capita healthcare spending:
You persist in treating endogenous factors as though they were exogenous. High costs in the U. S. raise the costs of healthcare everywhere. Besides why treat Medicare separately? We have one healthcare system not three or ten.
Rather than looking at OECD countries look at wages in healthcare. They’ve skyrocketed over the last 50 years. Just looking at professionals in 1970 the average wage of engineers, lawyers, architects, and physicians were within 10% of one another. Now the average wage of physicians is a multiple of the average wage of other professions.
And, no, I know it’s not just physicians. It’s wages throughout the sector. And then there’s the administrative costs. It’s the prices.
” We have one healthcare system not three or ten.”
I would dispute that a bit. We have different systems, with overlaps, lumped into one. Medicare actually has different rules than the commercial carriers. A different population also. Costs are totally different within those systems. (*Though we do spend about the same in public per capita spending as several European countries.)
http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective
While I think physical salaries will need to come down some, it is good to remember how much different things were in 1970. In the OR back then, they shut down all of the Ors as much as possible so everyone could have lunch together. If cases were running late, they just did them another day, they didn’t just stay late and finish them. ICUs had just been invented and weren’t all that widespread yet. OB floors didn’t run 24 hours a day like they do now.
Steve
I’m no economist but I can see the day coming when, insurance or not, whether you live or die will depend upon having the money. Insurance alone will not cover co-pays, whith can be beyond many peoples reach. In the third world, this is normal. Is it coming home?
The last time I checked nobody called public schools nationalized education or socialized education, but all my friends on the Right can use the free market. We sent my stepson to a Catholic grammar and high school, and we did not get any government goodies. (I believe that is how you all phrase them.)
New Orleans has had a Charity hospital for over 100 years, and the state has had something similar. It may not be the best, but it served the poor. (The trauma was one of the best in the country.) Most of the people you saw wading out of the water from Katrina had a Charity Hospital card.
If I understand my friends on the Right, I will need to get a Health Savings Account, and then, the free market will do its magic. I guess I will need to start getting the Sunday paper and look for healthcare specials.
“Buy two tonsillectomies and get one free.”
“$65.00 off your next heart transplant.”
“No money down and 0% financing on any surgeries at Big Bob’s Discount Surgery and Lumber Outlet”
It’s not like I do not have enough commercials about the drugs that will cure me and the lawyers that will sue them for killing me.
Here is an idea for all my free-market, free-trading Right wing friends. We can remove all the horrid nationalism and socialism and any non-free-market, free-tradism in your little (or big) tots life. We will abolish the public school system. You can take your free-market dollars and buy some free-trade education for little suzy and billy.
Once you have de-socialized and de-nationalized yourself, give me a call. Until then, blah, blah, blah, New Zealand, …