The hidden costs of Obamacare

Labor unions have been reliable supporters of President Obama and his policies. Their support for Obamacare was critical to its passage in 2010. Yet they are continuing to learn that their members will be paying more for their health care, not less.

One of the selling points of Obamacare was the lowering of health insurance costs. Nancy Pelosi promised, “Everybody will have lower rates.” President Obama was more specific, telling us that his signature program would “Bring down premiums by $2,500 for the typical family.” A year later, however, Mrs. Pelosi, in the face of rising premiums for many, forgot her promise of the previous year, “I don’t remember saying that everybody in the country would have a lower premium.”

Mrs. Pelosi’s sudden bout of amnesia isn’t surprising. Health insurance premiums rose up to 56 percent under Obamacare and some of her constituents in California are paying over $2600 per month in premiums. But that isn’t the worst of it.

Premiums are just the opening salvo for consumers paying for health care. Paying the premium means you have insurance, but that doesn’t mean you can leave your wallet home when visiting the doctor or hospital.

It’s the hidden costs that will thin your wallet. Copays, deductibles, and coinsurance to be specific. Insurance behemoth Cigna reassures us that these added costs, “All work together to help reduce your medical expenses and protect your finances.” Really?

The copayment is a fixed amount, typically between $20-40, that you pay each time you access the health care system — physician visit, x-ray, laboratory, or hospital.

Coinsurance can take a bigger bite out of your wallet. It’s not a fixed cost, but instead a percentage of your bill. Once you meet your deductible (the third hidden cost), you may still have to pay anywhere from 10 to 30 percent of your medical bill based on your policy coinsurance percentage.

The largest hit on your wallet, however, is the deductible. It’s this amount that you pay in full before insurance pays anything. Family deductibles range from $6000 to $10,000 for the most popular silver and bronze Obamacare plans. Until meeting the deductible, you might as well be uninsured, paying cash for your medical care.

It’s not just the Obamacare exchange plans with high deductibles. In 2013, 17 percent of employers are providing high deductible plans as the only option for employees. This is a 31 percent increase from the previous year, and a trend that will likely continue.

United Healthcare believes a high deductible plan is, “A more economical way to help protect your health.” Economical for whom? It certainly is for United but how about for the family suddenly on the hook for ten grand after a family member needs surgery or a few days in the hospital?

Some policies have an out-of-pocket maximum, limiting the cash hemorrhage. But read the fine print. The maximum may not include prescription drug costs or may only include prescription drugs. Copays may still be in effect even above and beyond the out-of-pocket maximum.

Here’s a novel idea to take the bite out of the high deductible. Let individuals or families prepay their deductible with a prepayment discount. Let’s say I have a $6000 deductible for my family insurance plan. Let me pay $5000 on January 1 and for the year my deductible is met. I save $1000 by accepting the gamble that my health care costs will exceed my deductible amount for the year. If my costs are lower, I lose the bet. But the insurance company gets cash up front, and unless I get sick on January 2, will have the use of that money until I spend up to my deductible.

Most states offer prepaid college tuition plans under the same concept. Pay in advance to secure a lower tuition bill, but with the risk of losing the prepayment if your kid ends up not going to college or going out of state.

The bottom line is that the insurance hidden costs, while euphemistically described as cost sharing, serve only as a subtle way to ration care. Faced with a high deductible, many will forgo seeking medical care hoping their problem goes away. If it doesn’t, then the only option is a trip to the emergency room, where by law, care must be provided for any “emergency medical condition.” And what a surprise, emergency room visits are increasing since Obamacare took effect.

Just as increasing income tax rates drives taxpayers toward loopholes, placing excessive cost burdens on the patient will incentivize poor decisions which ultimately increase costs for everyone.

Brian C. Joondeph is an ophthalmologist and can be reached on Twitter @retinaldoctor.  This article originally appeared in American Thinker.

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  • QQQ

    I am sorry for those who cannot pay their discounted premium, I really am. But, not so sorry that I am willing to pay it for them, which is what Obama Care is. Articles and the news keep talking about ‘subsidy’ pricing, and tax incentives. Wonder who is paying for that?

    Through good decisions, and a lot of luck, I have paid for myself It amazes me how there are a entire group of people who just keep holding out their hands and demanding to be taken care of. All they are missing are the cardboard signs.

    • Patient Kit

      The ACA is a mess and not working for many it was supposed to help and I hope some of the problems can be resolved. But I have no objection to my taxes subsidizing healthcare for others. I say that as someone who has worked and paid taxes my whole life, needed Medicaid for this last year when I was diagnosed with ovarian cancer after a layoff and the loss of the insurance plan I’d had for 18 years and now I’m about to start working and paying taxes again.

      If you object to your taxes subsidizing healthcare for others who really can’t afford it, would you be okay with, for example, all people without kids objecting to any of their taxes being spent on public education for other people’s kids?

      • Arby

        You must be reading my mind. I was recently thinking about my comments with SteveCaley and how I want choice in medical care. All those who see the government as the answer you can have their healthcare. I pay taxes like I do for schools even though I don’t have children was my exact thought. However, I only agree if I get the ability to work with doctors privately, cash or credit, for all but catastrophic care.

        There are good and poor providers of government care just as in private care, but government will always tell me where to go, when to go and how to behave. At least when I no longer wish to work with a private doctor, I can tell him where to go.

        • Dr. Drake Ramoray

          But in the not too distant future the regional monopoly owned PCMH/ACO will have you seeing a random PA/NP for your medical care, unless you have the resources for concierge care, or a doc sets up an affordable direct care practice.

          The era of the of personal physician in the United States is ending encouraged by the very medical societies that should be fightng with patients to preserve it. Medicine is losing its soul, the doctor/patient relationship. Instead you will be part of a population that will be “managed.”

          • DeceasedMD1

            The MD who phrased the term Medical Industrial complex just died, Dr. Relman. I had not realized the article he wrote in NEJM about this, is from 1980, well before I went to medical school.

            D@mn wish I had read this a long time ago.

            “The most important health-care development of the day is the recent, relatively unheralded rise of a huge new industry that supplies health-care services for profit. Proprietary hospitals and nursing homes, diagnostic laboratories, home-care and emergency-room services, hemodialysis, and a wide variety of other services produced a gross income to this industry last year of about $35 billion to $40 billion. This new “medical-industrial complex” may be more efficient than its nonprofit competition, but it creates the problems of overuse and fragmentation of services, overemphasis on technology, and “cream-skimming,” and it may also excercise undue influence on national health policy. In this medical market, physicians must act as discerning purchasing agents for their patients and therefore should have no conflicting financial interests. Closer attention from the public and the profession, and careful study, are necessary to ensure that the “medical-industrial complex” puts the interests of the public before those of its stockholders. (N Engl J Med. 1980; 303: 963–70.)”

          • Patient Kit


            RIP, Dr Reiman. You tried. If only people had taken what he had to say seriously back then. And by people, I mean doctors because you were the only ones reading medical journals back then. We lament some technology (like EMRs) a lot around here, but if we had the power of the Internet back then, maybe Dr Reiman’s ideas and warnings would have gotten out past doctors to the general public and patients. Since the MIC has been growing with leaps and bounds since 1980, the profit driven big business system is the only medical system that many of us have ever experienced, This is why I sometimes hiss like a cat when people blame Obamacare for all of our healthcare system problems. At least, the ACA is an attempt to try to do something. I wish people could remember that our healthcare system wasn’t working before the ACA either. That’s why we need to move forward, not go back to what we had pre-ACA.

            1980, people!

          • Margalit Gur-Arie

            Yes, 1980 is precisely where health care costs in the U.S. began diverging from the rest of the world, and also poverty rates began to climb consistently… One must wonder what exactly happened in the early 1980s….:-) because whatever it was, it brought us where we are today.

          • Jennifer Jonsson

            I think what happened was Reaganomics.

          • Patient Kit

            Definitely. Reaganomics played a big role in getting us to where we are today. People failed to pull themselves up by our own bootstraps while the powers that be pushed down aggressively and violently on our heads and shoulders and treated us like human pinatas. And as the wealthy got wealthier, it absolutely failed to trickle down. Epic fail on that trickling down thing. The idea that if people just work hard, they too can be rich is a lie. It’s a myth that serves those who work us like dogs in the name of productivity and efficiency and wider profit margins for them. Many people are working very hard in this country and finding it hard to survive, let alone get rich.

          • DeceasedMD1

            Even back then docs and the public, way too passive. You are one of the few, that take the time to think about it. Most people implicitly do not question. They trust the system or docs and are going to have a great shock coming when they need it.

          • Patient Kit

            I sure hope you’re wrong about that — that I’m one of the few that questions. I’m a child of the sixties who learned to question authority early and never stopped. There should be many questioners in my generation. My education (what there is of it, no degree here) is in old school journalism and research. I tend to dig into every angle and ferret out every aspect. I like to find out the whole story. And I will admit that I’m not shy about asking the tough questions. Ask a few docs here who I’ve grilled about the DPC model. ;-) My Research and Strategic Affairs Director boss used to call me a bulldog, LOL. He knew I never gave up until I found the answers to all my questions so he started assigning me more and more “almost impossible to find out” projects. I loved it. LOL! I can be pretty annoying, I guess. But not passive.

          • DeceasedMD1

            I can see that in you. They need you in the VA! But seriously, I am sure there are all kinds of jobs for you out there.

          • Patient Kit

            Thanks. I’m starting a 6 or 7 week freelance job on Tuesday working on a piece of a fairly mundane project. Nothing exciting but it will keep a roof over my head for a month. It may be just enough money to boot me off Medicaid and into the scary world of the uninsured. I don’t know yet what will happen health insurance wise. But at least I won’t be unemployed. My adventures in the social services and healthcare system continue. If my life wasn’t at stake, this last year would all be interesting firsthand research. Not looking forward to being uninsured again since the only time I was uninsured in the past, I was immediately diagnosed with OVCA. And I’m still in that phase when I’m supposed to be monitored every 3 months for recurrence. But hey! If I make $19/hr for 6 weeks that should be enough for me to get insurance on my own, right? Sigh.

          • DeceasedMD1

            Just got your message. I really wish you well on your job. Cant’ u find out ahead of time so that you can feel more secure about keeping your insurance?

          • Patient Kit

            What is this “security” thing of which you speak? ;-) No, unfortunately there is no way to find out ahead of time what the government’s HRA Dept will do with my case once they review it. Typically, when you start working, they keep you covered by Medicaid for a transitional period of time. I think that’s based on the idea that even when you get insurance from a new employer, the new insurance can take a few months to take effect. So, I’ll probably be covered by Medicaid for at least 3 months. There are variables though that effect what they decide. I’m only working freelance but I’m making more than double minimum wage ($19/hr and $28/hr for time worked over 40 hours). Of course, I may be unemployed again in 6 weeks. And then there is my cancer dx. My GYN ONC wrote a letter for me to try to help me get a longer extension of Medicaid based on the seriousness of my dx and my need for follow up care. We shall see what the government does with me. In the meantime, I continue to look for more permanent employment that comes with insurance. I have no choice but to live with the uncertainty as I try to claw my way back and rise from the ashes of the last 1.5 years.

            Thank you for your good wishes, DeceasedMD. A lot of bad things happened to me in a row (You should have seen me be my own lawyer in Housing Court!) but it feels like the tide is changing and I’m hopeful of lots of good things happening in a row now.

          • DeceasedMD1

            oh i hope things look up for you. You are very smart and have good things to offer which this world desperately needs!

          • Arby

            Believe me I have no desire to stick with the status quo. And, I am already a part of a population that is being “managed” just not completely in medicine although it is close.

            Like I have stated before I worked for a couple of banks. Did their malfeasance get the government to move for any lasting changes? No; we are in a more precarious situation than ever.

            Don’t you think if I thought the government could fix this or that they weren’t all largely bought off, I too would be sounding the mythical future of everyone covered for their healthcare if only we had government as a single payor.

          • drmeese

            My soul is being sucked dry. I hate it.

        • Patient Kit

          Re government run programs, my experience with Medicaid has not been bad. I applied for Medicaid the day before Thanksgiving 2012. I was approved in mid-December, a few weeks after applying. I knew when I was applying that I would have to choose one of a dozen managed care plans, so I did my research and made that choice in my application.

          I chose Healthfirst to manage Medicaid for me. That became effective on Jan 1, 2013. For the last two weeks of. December, I had access to healthcare via straight Medicaid. I chose Healthfirst based on the doctors and hospitals that are in their network. That info is available online on there website via their searchable database of in-network providers like any other insurance company. I also received a phonebook sized paper directory of my in-network choices for every medical specialty and ancillary service I could possibly need. There are a lot of choices.

          I chose to get my care within the NY Presbyterian system because it is so big and I knew there would be plenty of good doctor options if my cancer got complicated and I didn’t want to have to change insurance plans midway which, BTW, is an option. I could have switched from Healthfirst to another plan at any point.

          I called in December before my plan even kicked in and made my first appointment with a hospital-based GYN
          for Jan 4, 2013.. I saw that doc 4 days after my Healthfirst Medicaid became active. That doc was great. I liked her a lot. She ordered another CA125 blood test and vaginal ultrasound so she could see whether there were any changed in the cyst/tumor since the same tests were done by my previous private practice GYN. My new doc had those previous test results because I brought copies to her and handed them to her. When we got the new results, she sat down with me and discussed them and explained why she was referring me to her colleague, a GYN oncologist.

          He is terrific, both technically in the OR and interpersonally. He is compassionate, treats me like a whole person and has great communication skills. He performed successful robotic surgery on me in Feb
          2013 and continues to monitor me every 3 months. I never have any trouble getting an appointment with him and, so far, I have always gone in to the exam room within 15 minutes of arriving for my appointment. At one point, halfway between my first post-op visit and my 3 mo checkup, he talked to me on the phone for 20 minutes even though he is a very busy, popular doc. I trust him with my life. The first GYN that I saw at the hospital was very good too and I’d recommend either of these docs to anyone. They both accept plenty of insurances, private, Medicare and Medicaid. I plan on staying with my GYN ONC once I’m off Medicaid and covered by a different insurance. The first GYN I saw at the hospital could have done my surgery but she thought it would be better for me to have a GYN ONC do the surgery.

          Specialty care has been amazingly good on Medicaid. Primary care is more problematic. I chose to be seen for primary care at the hospital’s medical clinic because I thought it would be best to see a doc in the same system as my specialists. For primary care, that means I’m being treated by a resident who is supervised by an attending. That has been ok but not great like my specialist care. But it’s not bad. I get appointments easily and get what I need. And I could have gone elsewhere if I wanted to.

          My main point is that I have had plenty of choices on Medicaid — and good choices. I didn’t choose to go to the closest doctor who took Medicaid. I chose to go where I thought I could get the best care.

          I realize that my experience is only my experience and that (a) I’m a very proactive person and (b) there are a lot of good medical choices here in NYC. Still, my experience with government healthcare was nothing like the horror stories people talk about.

          By contrast, my previous private care GYN who was the doc who first found my cyst, is also the doc who told me while I was in stirrups that I probably had ovarian cancer and that if I voted of Obama, I’d get what I deserved. Then she told me that I needed to “find the money” for surgery. Then she abandoned me with no suggestions about where to go from there since I couldn’t find the money. The last two times I saw her, I was already uninsured and she wouldn’t see me until I paid her full bill upfront in cash. No check. No credit card. $150 in cash to see me for 5 minutes to tell me what she told me above. She never even wished me good luck with my cancer.

          I’ll take my amazing GYN ONC who accepts Medicaid any day over that private practice GYN.

          • Arby

            All your vignette says to me is that Presbyterian has good specialists working for them and a so-so general practice group and that you saw a jerk that only took private insurance. I wouldn’t go to that jerk either.

            I learned early working in hospitals it is not where you go, it is who you see that makes the difference in your care. That you had a good experience on Medicaid is fine; I wouldn’t wish you a even a medicoe one. However, the doctors were not working for the government here were they? They were running on the steam of a dying system that includes insurance companies that everyone rails against. Personally, I’ve never had an issue with an insurance company although I totally despise the way they run. And, you could say the care you got was purchased by insurance dollars, government, endowments or whatever way they can find. It does not equate to gov’t only care.

            So, what happens when gov’t is in charge of everything, expected to provide for everyone and needs to control costs. What do you think they will do to people’s choices in their care, including choice of provider then? They among all others have the power to dictate to you. They already dictate that health insurers cannot compete across state lines. Do you think that helps the consumer in any way?

            I just want you to understand that there is a segment of the population that would just like to see a doctor that doesn’t work directly for the government, a PCMH/ACO or an insurance company for the majority of their medical care.

          • Patient Kit

            I never meant to imply that my particular experience on Medicaid translates into what a single payor system would be in this country. I only wanted to point out that Medicaid hasn’t been the hellish experience people told me it would be. And it is a government (tax)-funded program. That doesn’t automatically make it bad. I was able to get excellent care on Medicaid and I did have choices. So when people point to Medicaid as how bad care will be if the government is the payor, I’m just saying: it wasn’t bad.

            A single payor system could take many forms. Different countries do it different ways. We need to figure out what would work in the US. I’m in favor of good comprehensive medical care for every American. And if some people want to pay to go outside of that system, fine. And if not a single payor system, I’d want to see more accountability and regulation of insurance companies.

            I’ve listened in detail to the argument for DPC and I reject that idea as a widespread model. I’m fine with it as an option, a niche. But not as the dominant model for primary care or any other healthcare services. Sorry but I’m just not buying that DPC would work for a lot of people.

          • Arby

            I venture to say that everyone on this blog wants good comprehensive medical care for everyone. Saying it doesn’t make it so or provide you with the moral high ground. For all any of us know, the system we end up may mean that going outside the system is one of the few ways to get it. People vote with their money too. Personally, I want the comprehensive medical plan the career politicians use.

            I am glad that you deign a niche market for those of us who choose it in direct care. You never know, it may just catch on with the patients who choose it.

          • Lisa

            I disagree with you that everyone on this blog wants good comprehemsive medical care for everyone. I think there are those don’t give a fig for people who can’t afford medical care, let alone good medical care.

          • Arby

            I don’t mean my reply below to come across as snarky as it sounds. I hope that by rubbing elbows with the poor you will see how the well-meaning generally look down on them in many ways. And on the other end of the spectrum, well-meaning attitudes can be easily manipulated by the con artists among us.

          • Patient Kit

            I give up, Arby. Clearly, nothing I say can change your opinion of me as some clueless “well-meaning” liberal working class woman who could never really care about the poor or hope to understand the poor or genuinely want to help the poor. Do you think my “well meaning” attitude only masks contempt for the poor?. Do you want me to just stop caring? I just don’t understand where your contempt for me is coming from or what I’ve done to deserve it.

          • Arby

            I’ve come to the same conclusion about giving up, but mostly because this blog really isn’t about poorness.

            I know you mean well and I don’t doubt you care about the poor which is why my replies have been measured. That I am snarky sometimes is from a lifetime of seeing repeated
            behaviors. That is my issue and I have tried to keep it in check.

            However, I do not say the things you keep writing that I am saying. You can understand the poor which is why I have approached this from the perspective of education, and not just for you; there are others here that may not be able to grasp that making decisions “for the poor” is demeaning to them in many ways, and that what others think will help the poor may very well end up making things worse for them. Again, I ask you to research how the government treats the mentally ill who really are at their mercy.

            Really, the only irksome thing I felt was when others wrote suggestions about how to make healthcare more affordable, you were quick to comment on how it would hurt the poor or is not feasible for everyone. I never got the impression that any of them were not trying to help the poor as well or that they were saying it was feasible for everyone. They were saying this is what worked for me, I hope you’ll consider it; they weren’t forcing it on anyone. And, I commented (too much perhaps) in instances where I thought it could help the working poor along with provisions made for the destitute and for those who lose everything to illness. Others here are trying to fight for the poor in their own way.

            The only other thought I will leave you with will surely offend you. But, know that I haven’t reached this state either and very few do. It is more something to strive for than anything because very few accomplish it: When you truly fight for the poor you don’t get personally offended and you don’t say you are a champion for the poor, because it isn’t about how kind others think you are or even what you think of yourself. At that point, isn’t about you at all.

            I won’t be commenting here for some time as I have my own illness to deal with. One that took me out of work and possibly will again. I won’t be needing healthcare for it because they don’t know what it is. No use paying for what they can’t find.

          • Patient Kit

            First, whatever illness you are dealing with, I hope you find your way through it. As someone who has gone through ovarian cancer this year, I know how frightening and stressful illness can be. I sincerely wish you well.

            I do not need to research the treatment of the mentally ill. My sister is a psychotherapist in NYC’s public hospital system, one of my oldest friends has been seriously mentally ill for a long time, I know all about the closing of hospitals and the de-institutionalization of the mentally illness and their subsequent revolving door re-institutionalization in our booming prisons. I know about the stigma. I’ve seen it hurt people I know and care about. You really don’t have a monopoly on hard life experience.

            I’m also not trying to be Mother Teresa. I’m not trying to “save” the poor. I know that a poor single mom knows better what she needs now than some Ivy League union leader or social worker who has never been in her position. If she says she needs a few more dollars a week now toning more food on the table now and Ivy League union leader says she needs a good pension for the future, I side with the mom who wants a little more food money now. Because I agree with you that she knows best what she needs most.

            I know that it’s not all about me. I do believe though that healthcare is a class issue in this country. What I hear you saying is that you feel more in control of the situation paying cash. Well, I feel like I’ve lost all control of the situation because I don’t have much cash. I’m just expressing my ideas about healthcare. I’m not holding a gun to anyone’s head to force them to agree with me. We have a lot of diverse opinions on this issue in this country right now. I’m just trying to discuss it. Being constantly told that I’m well-meaning feels very passive aggressive to me.

            Anyway, I wish you well in whatever you are currently dealing with. Over and out!

    • DeceasedMD1

      True QQQ. But aren’t the MIC (medical industrial complex) subsidized? Isn’t that where most of the burden lies? I agree there are people that expect things for free who can afford it. but this includes the MIC.

      • Patient Kit

        Yes, there is most definitely corporate welfare. But that doesn’t seem to bother tax-paying people nearly as much as poor people welfare bothers them. Why? Maybe because there is widespread contempt for the poor and widespread admiration for anyone or anything that can make money.

        I think one of the most destructive parts of American mythology is that myth that anyone, if they work hard enough, can get rich in America. That myth is why many people who aren’t rich and will never be rich tend to be reluctant to hurt the wealthy, some even going as far as protecting the wealthy. Why? Because some day they might be one of those wealthy people too.

        As far as welfare and Medicaid for the poor goes, I agree that it should be a safety net, not a lifestyle. I am a perfect example of how that works as a safety net. But as long as there are multiple pressures intended to keep poor people down, a humane culture has the responsibility to take care of them when they’re sick. If we want people to get out of poverty, maybe we should consider whether anyone can survive if we pay them a minimum wage of $7.25 an hour in 2014. If we want people off of Medicaid, we need to be concentrating on ways to really help people get out of poverty. Shawn Carter was raised by a single mother in public housing projects here in Brooklyn. But every kid can’t grow up to be Jay Z.

        • DeceasedMD1

          Well put. THe wealthy are protected and we live in a society that does not care about the poor, for the most part.And I think subsidized Corp Med goes much under the radar for most. They saw bank bailouts but don’t stop to think about this. And the most ingenious part is the wealthy can get the less fortunate to argue with each other about immigrants taking their last dollar or the medicaid population rather than a spot light on them.

        • Karen Ronk

          Patient Kit, I believe you are reading my thoughts. Spooky! Let us just be real. America hates poor people and sick people and disabled people. If you find yourself in that category, it is your fault. Not the fault of a greedy irresponsible employer. Not the fault of an inept physician. Not the fault of chronically bad choices made by clueless politicians. That whole work hard and play by the rules myth is just so 1970s.

          But we the people are the real problem. As a species, we have become narcissists on steroids. We settle for mediocrity and incompetence. We put ourselves first and foremost. We celebrate that handful of companies that actually treat their employees well and pay them fairly, yet continue to patronize the dozens who clearly do not.

          If you do not find yourself somewhat giddy when you actually get good service/care/help from someone, then I want to live wherever you live.

          Everything needs to change. Not just health insurance or how we get it and who pays for it. Wake me up when we get there.

  • QQQ

    “Just as increasing income tax rates drives taxpayers toward loopholes, placing excessive cost burdens on the patient will incentivize poor decisions which ultimately increase costs for everyone.”

    “Michael Savage: Obamacare Disaster FAKED To Bring In Obama’s Single Payer Socialist Dream”

  • James O’Brien, M.D.

    “Comprehensive” insurance isn’t insurance, it’s just prepayment of medical services. It’s what got us in trouble in the first place. Health insurance used to be called “hospitalization”. Meaning disasters, like cancer, ALS, getting hit by a bus. Not immunizations and ear infections and lipid management and psychotherapy for problems of everyday living.

    If your homeowners policy covered termites, fixing a sprinkler system and redecorating, premiums would soon go out tenfold. There is no mystery to those of use who understand actuarial risk.

    Someone needs to explain to the American people that one of the only ways to stave off national bankruptcy and these massive ACA premiums is that those routine visits to the PMD should be cash only.

    I am not optimistic that people are economically literate enough to understand this basic idea when some of the brightest people in society don’t.

    • Patient Kit

      Disagreeing with you does not equal economic illiteracy. I, for one, do not want to move to everyone only having catastrophic insurance and paying cash for everything else. Good comprehensive medical care for all Americans should just be in our budget. Cut other things but healthcare for all is too important. I’m fine with my tax dollars funding healthcare. One thing that would help the overall budget is cutting all the unnecessary visits to PCP for unnecessary antibiotics. I’d like to see an estimate of how much we collectively spend on that each year.

      Be careful not to romanticize the good old past too much. The reason that Medicare, Medicaid and comprehensive private insurance were created is because too many people could not afford even primary medical care — so they did without. And that is exactly what would happen again. If you can’t imagine people not being able to afford basic medical care, that doesn’t make it not so. Allowing the MIC to turn our healthcare system into a huge profit driven big business
      is another issue.

      But no thanks to health insurance being like car and homeowners insurance. I don’t own a car or home. But I can’t disown my body and mind. I pay cash for health maintenance in the form of such things as my gym membership and eating healthy foods. I don’t want to pay for my doctors that way.

      If we can’t fix the ACA, then I’d rather move to a single payer system than DPC + comprehensive insurance.

      • James O’Brien, M.D.

        If someone other than the consumer is paying for a good or service, the price goes up because there is no incentive to save. That’s basic economics.

        If you think single payor is a solution, well then I’m not going to try to counter with economic analysis, because you have faith that the government does things well. I say they have screwed up just about everything they touch. Look what they did to tuition and the housing market.

        Medicare provides health insurance not for the poorest but the wealthiest demographic. How much did a doctor’s appointment cost in 1965? How many people did without healthcare pre-1965? Do you have any evidence to back that up? What happened to health care costs after 1965? What role did the “Friendly Society” have in treating the indigent before Medicare? The good old days were a lot more affordable than what we have now and certainly single payor.

        • Patient Kit

          I don’t have as much faith in government as you think. But I have even less faith in the big businesses that are running things now. I’m on the street on my phone right now but I’ll get back to you on the numbers of Americans unable to afford healthcare, both then and now. But I’m absolutely sure that things weren’t any easier for some people before 1965 than they are now.

          Are you aware that 60% of people today working for $10 an hour or less in this country are adults, age 26-64? Some of them now qualify for Medicaid since their wages are so low. What do you think of a rich company like Walmart having a workforce that is paid so low that many of them qualify for Medicaid? Are you ok with that? Now do the math for someone working for $13 an hour and see how much healthcare you could afford on that. That’s about $21,800 (before taxes) if wou work 5 days a week every single week. Not a lot of room in the budget for doctors on that wage.

          If believing in and wanting a humane healthcare system makes me economically illiterate, so be it.

          • James O’Brien, M.D.

            TRUE OR FALSE: When someone can get something without paying for it directly, prices go up.

            I one cannot answer that question, I submit one is economically illiterate.

            Everyone thinks they’re a great humanist based upon what they think will work in utopia. I am not impressed. I want a system that works. The history of the last fifty years is replacing what works with what sounds good.

            And no, single payor (which is eventually coming, so you should be happy), won’t drop costs:


            And you didn’t answer any of my questions about healthcare costs fifty years ago, you just incorrectly asserted that people couldn’t afford to see a doctor. With zero evidence of that.

          • HJ

            “In a 1963 survey, patients from the general population were given a list of symptoms and asked whether they had been able to see a physician about them. Among those who reported “pains in the heart,” 25 percent said they did not see a physician; for “unexpected bleeding” it was 34 percent; for “shortness of breath,” it was 35 percent; for “abdominal pains,” it was 31 percent; for “repeated vomiting,” it was 40 percent; for “diarrhea for four or five days,” it was 38 percent.”

            “Overall, the study found that “the complex task of paying for necessary health services and providing adequate insurance for non-budgetable expenses remains beyond the economic capabilities of most aged persons.”

            “In the early 1960s, Aaron said, “health care was much less costly than it is today; and there was much less that doctors or hospitals could do for patients. It didn’t cost much for a hospital to let a heart attack victim lie in a bed or for a physician to stop by and prescribe nitroglycerin for someone with angina. It is rather different when pain in the chest calls for angiography and possibly for angioplasty and costly maintenance drugs. It is the rare physician today who can afford to give a full work-up to a person who presents with persistent chest pains, which calls for thousands of dollars worth of tests.””

          • James O’Brien, M.D.


          • HJ

            I find it interesting you make your arguments based the idea that almost everyone could afford medical care in the early 1960′s but don’t know where to find any evidence that things were just fine back then. I found this information in a few moments with Google. Did you do any research before making your assumptions?

            Of course, it doesn’t matter what the source is…in our current reality any study that disagrees with someone’s opinion is flawed and biased.

  • Jennifer Jonsson

    I have Obamacare and it’s fine. The premiums are $377 per month and the deductible is $3,000. The copays are decent and two of my prescription drugs are now free. I could have picked up a plan with a much higher deductible (as high as $6,000) and had much lower premiums, but for me, health care is really a case of “pay now or pay later.” I get no subsidies because I “earn too much”, but it’s affordable and I’m managing.

    One thing health care is NOT, is free. No matter where you get your insurance, from your employer or through the open market, you need to understand that you’ll be paying something eventually. I’d rather have the lower deductible so I don’t get slammed for a lot of money all at once if I’m in a car accident or some other catastrophe.

    • Patient Kit

      That’s good to know. I’ve been on Medicaid for a year after losing my longtime employer-provided Blue Cross plan after a layoff and now that I’m getting back to work (freelance with no insurance for now), I’m looking at my options for staying covered until I land a “permanent” job that comes with good insurance. Among those options are (A) a possible longer extension of transitional Medicaid under a special program for people with cancer (I was diagnosed with ovarian cancer after the layoff and loss of my BC but I might make too much money freelancing to qualify. Not sure yet.), (B) buying a plan on the exchange until I get a better one via employment or (C) (scary sigh) being uninsured for a while.

      I’m happy to hear that Obamacare is working for you. There is no way that a high-deductible bronze plan would work for me so I’m thinking higher premium silver or gold. Right now I’d probably qualify for a subsidy because I’m just getting back on my feet from absolute ground zero since I lost every penny I had during this odyssey. Do you mind saying what state you are in? I’m in NY.

  • nurse2u

    It is actually the insurance companies and big pharma that are paying the subsidies, not those of us who are paying for our insurance. I find the figures posed by this doctor questionable and he is forgetting the millions of people who were unable to get any kind of insurance because of their medical history. Was that right for the insurance companies to treat us that way? No, the big dollar is all the insurance companies care about, not the quality of care. This is quite noticeable when you look at what medical treatment is or isn’t covered by the insurance companies. A lot depends on the gender of the patient. I am old enough to remember the fight to get mammograms covered by health insurance and that was back in 1976. The ACA has helped to close that gap even further. Those of us who are able to pay for our insurance have to be responsible for those who can’t. That is how society functions. There are always the naysayers in the system, and I prefer to look at this as an ongoing growth process. It will never be perfect, but it will help to close gaps.

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