6 ms·

ACA is just a super expensive catastrophic insurance plan. I have to budget $2k/month for premiums and about $10k a year for unexpected visits to urgent care o

ACA is just a super expensive catastrophic insurance plan. I have to budget $2k/month for premiums and about $10k a year for unexpected visits to urgent care or the ER. So about $24k+$10k = $34k a year in after tax income. This doesn't include dental. That is another $4k to $8k/yearly depending on orthodontic treatment. For example this year, an ER visit is going to cost $7k after insurance. Last year a couple of urgent care visits cost $1k each after insurance. Even worse, in my market the number of insurers has dropped every year. A competitive "market" doesn't really exist. The ACA needed a parallel side to the legislation that aggressively attacked medical price inflation: taking on medical liability insurance reform, forcing price transparency across the entire medical system, fixing in-network vs out-network blackholes, etc. The ACA did nothing to fix the cost of medical care.

lotsofpulp 6y ago
> ACA is just a super expensive catastrophic insurance plan. Because healthcare is super expensive. > The ACA did nothing to fix the cost of medical care. ACA did not fix the root cause of the high cost of healthcare, which is low supply of healthcare. But insurance companies have been able to slow the rise in healthcare costs: https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/ https://www.healthsystemtracker.org/chart-collection/u-s-spe...
- sudosysgen 6y ago
  In Canada, we pay around 7k$ CAD on healthcare, or 5300 USD, with better outcomes. It is expensive, but not 34k$ a year expensive. Actually, about a seventh!
  - lotsofpulp 6y ago
    Healthcare providers have far lower incomes in Canada than the US.
    - sudosysgen 6y ago
      Not 3-7 times as much on aggregate , and if that's the case then the US has a problem.
  - otoburb 6y ago
    Where are you getting the $7K CAD number from? There's a similar number floating around from the Canadian Institute for Health Information[1] but that same source also lists USA per capita expenditure at $14K[2], and not $34K USD. It seems that much of the funding for the Canadian healthcare system(s) is funded by provincial tax revenue supplemented with federal transfer payments. There's a reason why our tax system generally works out to be a higher tax burden compared to most American locales. [1] https://www.cihi.ca/en/national-health-expenditure-trends-1975-to-2019 https://www.cihi.ca/en/national-health-expenditure-trends-19... [2] https://www.cihi.ca/en/how-does-canadas-health-spending-compare https://www.cihi.ca/en/how-does-canadas-health-spending-comp...
    - sudosysgen 6y ago
      Yes, if you have employer given Healthcare and so on you can get it down to around 14k, which is still almost three times more. But if you're buying it on the open market, alone, it'll run you around 30K for equivalent coverage. Our taxes are generally higher, but not significantly so for the median person, and healthcare spending is, everything considered, cheaper and as good. So the system is more efficient.
      - marcusverus 6y ago
        >But if you're buying it on the open market, alone, it'll run you around 30K for equivalent coverage. Way, way off. Median annual cost without an employer contribution for a 27 y/o single person is ~$4700. Median cost for a family of four is ~$18000. www.nytimes.com/2019/10/22/us/politics/obamacare-trump.amp.html
        sudosysgen 6y ago
        The 27 y/o single person is not the average case, and that is only the cost of insurance, not including deductibles and other costs, electives, or drugs, which are included in the above mentioned numbers. Finally, many people are simply not eligible for Obamacare.
tasuki 6y ago
Gee, am I just lucky or careless or both? I'm 35 and have not needed a doctor visit for 10+ years. I've gone for perhaps one regular check-up once in the past 5 years and have only seen my dentist in a pub during that time frame.
- testfoobar 6y ago
  Stay healthy. I have a family of four that is thankfully healthy. Things still happen. E.g. kidney stones, an unexpected mass somewhere that needs to be biopsied and turns out benign, falls and scrapes, etc. All need engagement with the medical care system and all are fraught with unexpected expenses. The $7k (out-of-pocket for me) ER visit was billed at $27k to the insurance.
  - tasuki 6y ago
    What is "unexpected mass"? Where I'm from, "falls and scrapes" are generally self-medicated with water and peroxide and don't need engagement with the medical care system unless something's broken. When I was in school, most of the minor accidents were handled just fine by the teachers.
    - nitrogen 6y ago
      What is "unexpected mass"? Tumor/growth/lump/etc.
      - tasuki 6y ago
        I see, thanks. I've had these two hard lumps in my right leg for like 10 years, perhaps I should tell a doctor or something.
- mjayhn 6y ago
  At my healthiest at 31, tons of marathoning and cycling going back a decade I got appendicitis out of the blue, it was $35k and about 15 minutes in the OR. Back to healthy now but wow that literally came out of nowhere and I learned a lot of humility about the parts of my body I'm not bruising/breaking.
wahern 6y ago
> The ACA needed a parallel side to the legislation that aggressively attacked medical price inflation: taking on medical liability insurance reform, forcing price transparency across the entire medical system, fixing in-network vs out-network blackholes, etc. Most of the text of the ACA attempted to do exactly that. The problem is that there are no simple answers, the rhetoric notwithstanding. The ACA created rules and processes built around consensus advice for controlling costs, but predictably the results were more meager than the rhetoric and studies claimed. But it was always understood that would likely happen. Much of the ACA also included data acquisition and feedback mechanisms that would feed into both regulatory committees and into subsequent reform legislation. But the GOP stonewalled both mechanisms. Remember, their sole desire was repeal. Replace or even supplement was never on the table for most of the past 12 years, and offered proposals were never made in good faith because they were always patently deficient.[1] To the extent the ACA has failed (and that's debatable because people have very rose-colored glasses about the previous state of affairs), it's because it was deliberately sabotaged. [1] For example, prohibiting denial for preexisting conditions but removing the universal mandate is patently not fiscally viable! Certainly not without a hefty tax increase to reimburse insurers, a process (temporary under ACA) which the GOP also subverted. That's not even Econ 101, but Kindergarten Econ.

lotsofpulp 6y ago

> ACA is just a super expensive catastrophic insurance plan. Because healthcare is super expensive. > The ACA did nothing to fix the cost of medical care. ACA did not fix the root cause of the high cost of healthcare, which is low supply of healthcare. But insurance companies have been able to slow the rise in healthcare costs: https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/ https://www.healthsystemtracker.org/chart-collection/u-s-spe...

sudosysgen 6y ago
In Canada, we pay around 7k$ CAD on healthcare, or 5300 USD, with better outcomes. It is expensive, but not 34k$ a year expensive. Actually, about a seventh!
- lotsofpulp 6y ago
  Healthcare providers have far lower incomes in Canada than the US.
  - sudosysgen 6y ago
    Not 3-7 times as much on aggregate , and if that's the case then the US has a problem.
- otoburb 6y ago
  Where are you getting the $7K CAD number from? There's a similar number floating around from the Canadian Institute for Health Information[1] but that same source also lists USA per capita expenditure at $14K[2], and not $34K USD. It seems that much of the funding for the Canadian healthcare system(s) is funded by provincial tax revenue supplemented with federal transfer payments. There's a reason why our tax system generally works out to be a higher tax burden compared to most American locales. [1] https://www.cihi.ca/en/national-health-expenditure-trends-1975-to-2019 https://www.cihi.ca/en/national-health-expenditure-trends-19... [2] https://www.cihi.ca/en/how-does-canadas-health-spending-compare https://www.cihi.ca/en/how-does-canadas-health-spending-comp...
  - sudosysgen 6y ago
    Yes, if you have employer given Healthcare and so on you can get it down to around 14k, which is still almost three times more. But if you're buying it on the open market, alone, it'll run you around 30K for equivalent coverage. Our taxes are generally higher, but not significantly so for the median person, and healthcare spending is, everything considered, cheaper and as good. So the system is more efficient.
    - marcusverus 6y ago
      >But if you're buying it on the open market, alone, it'll run you around 30K for equivalent coverage. Way, way off. Median annual cost without an employer contribution for a 27 y/o single person is ~$4700. Median cost for a family of four is ~$18000. www.nytimes.com/2019/10/22/us/politics/obamacare-trump.amp.html
      - sudosysgen 6y ago
        The 27 y/o single person is not the average case, and that is only the cost of insurance, not including deductibles and other costs, electives, or drugs, which are included in the above mentioned numbers. Finally, many people are simply not eligible for Obamacare.

tasuki 6y ago

Gee, am I just lucky or careless or both? I'm 35 and have not needed a doctor visit for 10+ years. I've gone for perhaps one regular check-up once in the past 5 years and have only seen my dentist in a pub during that time frame.

testfoobar 6y ago
Stay healthy. I have a family of four that is thankfully healthy. Things still happen. E.g. kidney stones, an unexpected mass somewhere that needs to be biopsied and turns out benign, falls and scrapes, etc. All need engagement with the medical care system and all are fraught with unexpected expenses. The $7k (out-of-pocket for me) ER visit was billed at $27k to the insurance.
- tasuki 6y ago
  What is "unexpected mass"? Where I'm from, "falls and scrapes" are generally self-medicated with water and peroxide and don't need engagement with the medical care system unless something's broken. When I was in school, most of the minor accidents were handled just fine by the teachers.
  - nitrogen 6y ago
    What is "unexpected mass"? Tumor/growth/lump/etc.
    - tasuki 6y ago
      I see, thanks. I've had these two hard lumps in my right leg for like 10 years, perhaps I should tell a doctor or something.
mjayhn 6y ago
At my healthiest at 31, tons of marathoning and cycling going back a decade I got appendicitis out of the blue, it was $35k and about 15 minutes in the OR. Back to healthy now but wow that literally came out of nowhere and I learned a lot of humility about the parts of my body I'm not bruising/breaking.

wahern 6y ago

> The ACA needed a parallel side to the legislation that aggressively attacked medical price inflation: taking on medical liability insurance reform, forcing price transparency across the entire medical system, fixing in-network vs out-network blackholes, etc. Most of the text of the ACA attempted to do exactly that. The problem is that there are no simple answers, the rhetoric notwithstanding. The ACA created rules and processes built around consensus advice for controlling costs, but predictably the results were more meager than the rhetoric and studies claimed. But it was always understood that would likely happen. Much of the ACA also included data acquisition and feedback mechanisms that would feed into both regulatory committees and into subsequent reform legislation. But the GOP stonewalled both mechanisms. Remember, their sole desire was repeal. Replace or even supplement was never on the table for most of the past 12 years, and offered proposals were never made in good faith because they were always patently deficient.[1] To the extent the ACA has failed (and that's debatable because people have very rose-colored glasses about the previous state of affairs), it's because it was deliberately sabotaged. [1] For example, prohibiting denial for preexisting conditions but removing the universal mandate is patently not fiscally viable! Certainly not without a hefty tax increase to reimburse insurers, a process (temporary under ACA) which the GOP also subverted. That's not even Econ 101, but Kindergarten Econ.