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Well if we stop calling products insurance that are not insurance it might be a step in the right direction. I think catastrophic medical insurance should exist

Well if we stop calling products insurance that are not insurance it might be a step in the right direction. I think catastrophic medical insurance should exist and that earns the name "insurance". What most people perceive as insurance is really a service plan. You pay a fee to have services selected on the plan to be available when you want them and you get provided with a list of those who can deliver. Still the real bogeyman is just like income taxes most people don't see the cost first hand or don't associate it with their income. They see the final check value and somehow disconnect the costs. The step is getting name insurance off of products that are not insurance

maxerickson 10y ago
The costs of the services in the bronze ACA plans isn't that high. They basically are catastrophic plans. The premiums and deductibles are expensive because medical care is expensive and a real medical catastrophe can have obscene costs. Cheaper coverage can pretty much only be obtained by excluding people or limiting the benefit.
- zanny 10y ago
  Which goes against all the evidence - every other first world country with universal coverage that also provides all the same medical services the US does, while paying a third as much per person. The US pays more for a lot of reasons. It isn't a one trick pony: * Americans are much, much more unhealthy than Europeans on average. Way more obesity, way more smoking and drinking for addiction rather than socialiation. * The insurance apparatus imposes a ~20% overhead outright on expenses, and puts further money on top by moving costs out of the consumers hands. They control what doctors you see and what procedures and drugs you get, and often do so in ways that are locally beneficial to the insurer but are more inefficient than a universal system. * Hospitals and doctors, by being decoupled from patient expenses by the insurers, run rampant on spending and salary and hospital administration gets as crooked as insurance bureaucracy. Your healthcare dollar quickly ends up going 60% to bureaucrats and institutionalized middle-men expenses and only 40% to actual care. Solving #1 is something that has to be done over time, and the only way to do that is to have a healthcare system, any system, that stops disincentivizing people from seeing doctors except for during crisis. The ACA did very little to fix this (it basically only mandated that some routine preventative care came at no cost to patients) and until you can get the general unhealthiness of Americans under control you can't get costs under control regardless of healthcare system. The other two, though? Single payer solves them either immediately or with the market pressure of the entire US populations healthcare needs. Every other developed country that adopted single payer was able to use its influence to get hospitals and private insurance in line. That is why the UK now has one of the best systems in the world.
  - maxerickson 10y ago
    The ACA did very little to fix this (it basically only mandated that some routine preventative care came at no cost to patients) This is what I meant by services (and also things like birth control and so on that are mandated in the plans but "part of life" rather than related to a change in health or injury). edit: and I think you were responding in part because the services are more expensive than they need to be. My meaning was that they don't drive up the premiums of the insurance all that much (and with the large deductibles, in many cases the annual premiums together are not the largest component of the patient's contribution towards a large medical expense).
- stevenwoo 10y ago
  Anecdotally in my case that is not true - this may be due to your age that you didn't see the difference, I was I think 47 when this switch happened. I had catastrophic health insurance for $135 per month in California pre - Obamacare with no prescriptions or treatment for pre existing conditions/maintenance of health. The minimum insurance on the CA marketplace was 350 per month for me then, now it's 440 a month.
  - maxerickson 10y ago
    Did the plan you had before have annual and lifetime spending caps?
    - stevenwoo 10y ago
      Yes IIRC it did. Forgot to mention California's market place eliminated catastrophic insurance plans so residents of California kind of got burned by the promise of keeping one's current plan.

maxerickson 10y ago

The costs of the services in the bronze ACA plans isn't that high. They basically are catastrophic plans. The premiums and deductibles are expensive because medical care is expensive and a real medical catastrophe can have obscene costs. Cheaper coverage can pretty much only be obtained by excluding people or limiting the benefit.

zanny 10y ago
Which goes against all the evidence - every other first world country with universal coverage that also provides all the same medical services the US does, while paying a third as much per person. The US pays more for a lot of reasons. It isn't a one trick pony: * Americans are much, much more unhealthy than Europeans on average. Way more obesity, way more smoking and drinking for addiction rather than socialiation. * The insurance apparatus imposes a ~20% overhead outright on expenses, and puts further money on top by moving costs out of the consumers hands. They control what doctors you see and what procedures and drugs you get, and often do so in ways that are locally beneficial to the insurer but are more inefficient than a universal system. * Hospitals and doctors, by being decoupled from patient expenses by the insurers, run rampant on spending and salary and hospital administration gets as crooked as insurance bureaucracy. Your healthcare dollar quickly ends up going 60% to bureaucrats and institutionalized middle-men expenses and only 40% to actual care. Solving #1 is something that has to be done over time, and the only way to do that is to have a healthcare system, any system, that stops disincentivizing people from seeing doctors except for during crisis. The ACA did very little to fix this (it basically only mandated that some routine preventative care came at no cost to patients) and until you can get the general unhealthiness of Americans under control you can't get costs under control regardless of healthcare system. The other two, though? Single payer solves them either immediately or with the market pressure of the entire US populations healthcare needs. Every other developed country that adopted single payer was able to use its influence to get hospitals and private insurance in line. That is why the UK now has one of the best systems in the world.
- maxerickson 10y ago
  The ACA did very little to fix this (it basically only mandated that some routine preventative care came at no cost to patients) This is what I meant by services (and also things like birth control and so on that are mandated in the plans but "part of life" rather than related to a change in health or injury). edit: and I think you were responding in part because the services are more expensive than they need to be. My meaning was that they don't drive up the premiums of the insurance all that much (and with the large deductibles, in many cases the annual premiums together are not the largest component of the patient's contribution towards a large medical expense).
stevenwoo 10y ago
Anecdotally in my case that is not true - this may be due to your age that you didn't see the difference, I was I think 47 when this switch happened. I had catastrophic health insurance for $135 per month in California pre - Obamacare with no prescriptions or treatment for pre existing conditions/maintenance of health. The minimum insurance on the CA marketplace was 350 per month for me then, now it's 440 a month.
- maxerickson 10y ago
  Did the plan you had before have annual and lifetime spending caps?
  - stevenwoo 10y ago
    Yes IIRC it did. Forgot to mention California's market place eliminated catastrophic insurance plans so residents of California kind of got burned by the promise of keeping one's current plan.