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>>> Insurance companies and Pharmaceutical companies can more or less dictate the prices they'll charge because if you're chronically ill, you can't just choose

>>> Insurance companies and Pharmaceutical companies can more or less dictate the prices they'll charge because if you're chronically ill, you can't just choose not to be treated (unless you're ok with dying.) How is this consistent with the pre-ACA availability of high deductible, low premium PPO plans in low-regulation states? As an example, in 2008, a middle aged man could buy such a plan in Arizona for $70/month with a $10K deductible and $2 million lifetime coverage. This included free annual wellness visits, women's wellness checkups, etc. Keep $10K in the bank for emergencies, and you're good to go. Millions of self-employed people and people working jobs that provided no group insurance benefits were able to take advantage of these products. I was able to insure my family of three for $330 a month at that time, and the coverage was quite good. I don't fully understand the single payer concept, except that it essentially is a form of national health insurance similar to the British NHS. For a country as big and diverse as the U.S., it sounds expensive and unworkable. I would propose as an alternative a hybrid of low-regulation plans such as we had prior to ACA, plus support for those who can't even afford one of these low price plans. Free or low fee clinics for the needy, less regulatory load on hospitals and small practices, e.g. remove or delay the electronic medical record requirement, attack the causes of high malpractice insurance, stop incentivizing physicians to "turf" challenging patients off to specialists and overprescription of tests to cover their liability. There has to be a way that works, short of a national Medicare for all that I fear would lead to great mediocrity.

GiorgioG 10y ago
> I don't fully understand the single payer concept, except that it essentially is a form of national health insurance similar to the British NHS. Here's why single payer works to keep costs in check everywhere it's implemented: Providers and pharmaceutical companies have only 1 organization to negotiate with. Another alternative that won't see the light of day is cost regulation for the entire industry. My sons type 1 diabetes supplies for a quarter bill my insurance plan $6000. There's not more than a couple of hundred dollars worth of materials there (and I'm being generous.) A friend of mine takes Gleevec, a leukemia drug, costing his insurer $14,000 per month. Generics are now coming on the market for a much "cheaper" $38,000/year. That same generic in Canada is $8,800/year. We're being systematically ripped off.
- blisterpeanuts 10y ago
  Not a rip-off, but a consequence of lower regulations in the U.S. Through higher domestic prices you are subsidizing the lower prices in most other countries for American-developed drugs. You are also subsidizing the R&D. A single drug can cost billions (with a "B") of dollars to develop, test, and manufacture. It takes years of experimentation and careful trials, and even after the chemical is approved by the FDA, there are hundreds of millions of dollars in liability insurance baked into the price against the almost inevitable class action suit should there be an unforeseen side effect. For example, Roche has developed an MS drug, ocrelizumab, which attacks B cells exclusively and appears to slow the progression of the disease. It's in stage 3 tests and has cost well over $1 billion so far. There is a large market for this treatment, should it ever make it out of the lab. The problem is, a side effect may cause the FDA to deny approval, and there is no particular compensation. Maybe they can use the knowledge to develop a better drug, or maybe it will help some other research organization. Either way, it's a very expensive and risky gambit. The way they recoup their costs is by charging a lot up front. Since Canada and other countries cap the prices they can charge, they can only do so in the domestic market. I'm not saying I approve of this approach. Frankly if I had MS I'd not want to wait 5 years for the FDA to declare it perfectly safe. I used to volunteer in an MS clinic and I can tell you, people were often willing to take the risk. Tysabri was another one that was amazingly successful against MS, but it also activated a rare and fatal virus in the brain in a very small number of patients, so it was pulled off the market. I've read that it's being allowed in limited cases.
gamblor956 10y ago
As an example, in 2008, a middle aged man could buy such a plan in Arizona for $70/month with a $10K deductible and $2 million lifetime coverage. This included free annual wellness visits, women's wellness checkups, etc. Keep $10K in the bank for emergencies, and you're good to go. The key word you're looking for here is "high deductible." $10k is a very high deductible; it essentially renders the medical plan useless for anything short of emergency or life-threatening care. Most people don't just have $10k lying around.
- brightsize 10y ago
  If said middle-age man had expensive chronic conditions to treat then that $70/mo policy would quickly become a $10840/yr policy. That might be workable for a high-earner but even for the average-income American it likely wouldn't be.
  - blisterpeanuts 10y ago
    Yet, in the pre-Medicare days, this is exactly what families were faced with when someone got seriously sick: they had to pool their money to pay for treatment. Today, people resent even paying the co-pay, and the notion of coming up with a few thousand dollars that might be a small fraction of the bills would be considered outrageous and unfair.
bduerst 10y ago
>I was able to insure my family of three for $330 a month at that time, and the coverage was quite good. Whenever I see a like claim tossed around I always ask (and never get a straight answer): What was your deductible and out of pocket maximum for your family of 3 at $300/mo?
- blisterpeanuts 10y ago
  It was a high deductible plan, $7500 as I recall. We had enough savings that the tradeoff made sense. For some conditions, the high deductible was waived. I don't remember now what they were.
  - bduerst 10y ago
    Right, but what was your Max out of pocket? If you can't remember these details then how can you say it was a good plan?
nodamage 10y ago
> As an example, in 2008, a middle aged man could buy such a plan in Arizona for $70/month with a $10K deductible and $2 million lifetime coverage. This included free annual wellness visits, women's wellness checkups, etc. Keep $10K in the bank for emergencies, and you're good to go. 1. Only if you were already in good health and had no pre-existing conditions. Otherwise you would be rejected. 2. $2 million lifetime limit is not great for certain illnesses that can become very expensive to treat (e.g. cancer). 3. The practice of recission meant that you had no idea whether or not that $70/month plan would actually pay out in the event that you needed it. Insurance plans were great for insurance companies pre-ACA, you could reject everyone except those least likely to need health care, and then drop their coverage if it turned out they actually needed it, or if they got too expensive to treat. It was a win-win-win situation for the insurance companies.
- blisterpeanuts 10y ago
  You're going to the extreme case of catastrophic coverage. For the majority of common conditions such as appendicitis, broken bones, even some types of heart disease, this type of plan worked quite well. It's true that a catastrophic case could blow through the lifetime cap, but then there was something else called catastrophic coverage for not that much more. I chose not to get it, but maybe should have. I suspect it's not so much that the coverage was prohibitive but that people simply didn't, and don't, understand the economics. A lot of people were knowingly going "bare", i.e. foregoing coverage altogether. Even today, people are consciously choosing to pay the personal penalty. Your claim that "you could reject everyone" pre-ACA is completely false. In fact, insurance companies were required to carry a certain percentage of high liability customers. It varied from state to state, though. Finally it's also worth mentioning that even for people with no coverage whatsoever, hospitals were (and are) required to care for them. If you stumble into the ER with any condition, they are required to provide care, or at least transport you quickly to a place that can. The poorest among us will get excellent care albeit they may not have the wherewithal and knowledge to actually go seek out that care. The ACA sought to rationalize this fragmented and confused system and deploy a universal system throughout the country. It will be a subject of debate for decades to come whether this law would have worked.

GiorgioG 10y ago

> I don't fully understand the single payer concept, except that it essentially is a form of national health insurance similar to the British NHS. Here's why single payer works to keep costs in check everywhere it's implemented: Providers and pharmaceutical companies have only 1 organization to negotiate with. Another alternative that won't see the light of day is cost regulation for the entire industry. My sons type 1 diabetes supplies for a quarter bill my insurance plan $6000. There's not more than a couple of hundred dollars worth of materials there (and I'm being generous.) A friend of mine takes Gleevec, a leukemia drug, costing his insurer $14,000 per month. Generics are now coming on the market for a much "cheaper" $38,000/year. That same generic in Canada is $8,800/year. We're being systematically ripped off.

blisterpeanuts 10y ago
Not a rip-off, but a consequence of lower regulations in the U.S. Through higher domestic prices you are subsidizing the lower prices in most other countries for American-developed drugs. You are also subsidizing the R&D. A single drug can cost billions (with a "B") of dollars to develop, test, and manufacture. It takes years of experimentation and careful trials, and even after the chemical is approved by the FDA, there are hundreds of millions of dollars in liability insurance baked into the price against the almost inevitable class action suit should there be an unforeseen side effect. For example, Roche has developed an MS drug, ocrelizumab, which attacks B cells exclusively and appears to slow the progression of the disease. It's in stage 3 tests and has cost well over $1 billion so far. There is a large market for this treatment, should it ever make it out of the lab. The problem is, a side effect may cause the FDA to deny approval, and there is no particular compensation. Maybe they can use the knowledge to develop a better drug, or maybe it will help some other research organization. Either way, it's a very expensive and risky gambit. The way they recoup their costs is by charging a lot up front. Since Canada and other countries cap the prices they can charge, they can only do so in the domestic market. I'm not saying I approve of this approach. Frankly if I had MS I'd not want to wait 5 years for the FDA to declare it perfectly safe. I used to volunteer in an MS clinic and I can tell you, people were often willing to take the risk. Tysabri was another one that was amazingly successful against MS, but it also activated a rare and fatal virus in the brain in a very small number of patients, so it was pulled off the market. I've read that it's being allowed in limited cases.

gamblor956 10y ago

As an example, in 2008, a middle aged man could buy such a plan in Arizona for $70/month with a $10K deductible and $2 million lifetime coverage. This included free annual wellness visits, women's wellness checkups, etc. Keep $10K in the bank for emergencies, and you're good to go. The key word you're looking for here is "high deductible." $10k is a very high deductible; it essentially renders the medical plan useless for anything short of emergency or life-threatening care. Most people don't just have $10k lying around.

brightsize 10y ago
If said middle-age man had expensive chronic conditions to treat then that $70/mo policy would quickly become a $10840/yr policy. That might be workable for a high-earner but even for the average-income American it likely wouldn't be.
- blisterpeanuts 10y ago
  Yet, in the pre-Medicare days, this is exactly what families were faced with when someone got seriously sick: they had to pool their money to pay for treatment. Today, people resent even paying the co-pay, and the notion of coming up with a few thousand dollars that might be a small fraction of the bills would be considered outrageous and unfair.

bduerst 10y ago

>I was able to insure my family of three for $330 a month at that time, and the coverage was quite good. Whenever I see a like claim tossed around I always ask (and never get a straight answer): What was your deductible and out of pocket maximum for your family of 3 at $300/mo?

blisterpeanuts 10y ago
It was a high deductible plan, $7500 as I recall. We had enough savings that the tradeoff made sense. For some conditions, the high deductible was waived. I don't remember now what they were.
- bduerst 10y ago
  Right, but what was your Max out of pocket? If you can't remember these details then how can you say it was a good plan?

nodamage 10y ago

> As an example, in 2008, a middle aged man could buy such a plan in Arizona for $70/month with a $10K deductible and $2 million lifetime coverage. This included free annual wellness visits, women's wellness checkups, etc. Keep $10K in the bank for emergencies, and you're good to go. 1. Only if you were already in good health and had no pre-existing conditions. Otherwise you would be rejected. 2. $2 million lifetime limit is not great for certain illnesses that can become very expensive to treat (e.g. cancer). 3. The practice of recission meant that you had no idea whether or not that $70/month plan would actually pay out in the event that you needed it. Insurance plans were great for insurance companies pre-ACA, you could reject everyone except those least likely to need health care, and then drop their coverage if it turned out they actually needed it, or if they got too expensive to treat. It was a win-win-win situation for the insurance companies.

blisterpeanuts 10y ago
You're going to the extreme case of catastrophic coverage. For the majority of common conditions such as appendicitis, broken bones, even some types of heart disease, this type of plan worked quite well. It's true that a catastrophic case could blow through the lifetime cap, but then there was something else called catastrophic coverage for not that much more. I chose not to get it, but maybe should have. I suspect it's not so much that the coverage was prohibitive but that people simply didn't, and don't, understand the economics. A lot of people were knowingly going "bare", i.e. foregoing coverage altogether. Even today, people are consciously choosing to pay the personal penalty. Your claim that "you could reject everyone" pre-ACA is completely false. In fact, insurance companies were required to carry a certain percentage of high liability customers. It varied from state to state, though. Finally it's also worth mentioning that even for people with no coverage whatsoever, hospitals were (and are) required to care for them. If you stumble into the ER with any condition, they are required to provide care, or at least transport you quickly to a place that can. The poorest among us will get excellent care albeit they may not have the wherewithal and knowledge to actually go seek out that care. The ACA sought to rationalize this fragmented and confused system and deploy a universal system throughout the country. It will be a subject of debate for decades to come whether this law would have worked.