I am a fierce champion of single payer. I am on the board of California OneCare, one of the most active single payer organizations in California. But right now, we are several heartbeats away from the opening of the health insurance exchanges. So let's take a real world look at what we might expect.
Take a deep breath and continue reading.
The task facing the administration is Herculean, quite literally changing the psyche of the American people. American have long accepted that in this country healthcare is a privilege reserved to the affluent and those still with employer provided insurance. We're now being told, throw away those beliefs the future is here, and the future belongs to those who buy for-profit private insurance.
We've segued from each man/woman for herself, to we're all in this together.
The biggest and most critical hurdle is to sell the young 18-34 year old cohort on the need for them to enroll. Without this group of Americans, which the Administration estimates is around 2.7 million strong, the exchanges will implode due to a phenomenon called adverse selection.
Despite my grave reservations and deep concern about the implementation of Obamacare, I would urge anyone who can lend a hand, to go to the web site of Enroll America and do whatever you can, to help get young people happily enrolled. Without their participation, We. Are. Toast.
As Robert Pear wrote yesterday in the New York Times,"For Obamacare to Work, Everyone Must Be In". And the sine qua non of the ACA are the young invincibles who must be persuaded to enroll.
So struggling Americans, still reeling from the 2008 crisis, are being asked/required to accept the for-profit insurance industry, and pay staggering premiums and deductibles, just to get a foot in the door to the most expensive, but far from the best healthcare system in the world. We are being told that the barbaric belief system which continues to be embraced by tens of millions, that healthcare is only for those who can pay, is all wrong, and a new day has arrived.
Up until now, healthcare in the United States has been a privilege. Some would argue, and I would agree, that even with the new day we are all awaiting, healthcare will remain a privilege and as many of us have long feared, many/most of us who will comply with the law, will have insurance in name only.
What do we mean by insurance in name only?
The situation in New York State is instructive, and helps explain what it means to be insured, but in reality to be dangerously underinsured.
A few weeks ago, headlines trumpeted that New York would see premiums drop by up to 50%. This was misleading. New York had among the highest premiums in the nation because we are a pure community rating, guaranteed issue state--one of six or seven community rating states in the country.
This meant that insurers had to sell insurance to anyone who could pay for it. Pre-existing conditions did not taint New York State. Young and old, all paid the same. So, guess what happened? Young people dropped out, and the pool shrunk to just people who really needed to be insured--the sick, those with chronic conditions. New York could brag about offering health insurance to everyone--with one caveat, if you could pay among the highest rates in the country! I would be dead or would have filed for medical bankruptcy, if I weren't a resident of NY State.
Obamacare is supposed to ameliorate this problem of adverse selection by mandating that everyone buy, so the older and sicker will in effect be subsidized by the young and healthy.
But returning to the reality on the ground, what kind of check will I and other New Yorkers be writing every month, and what will we get for it?
Here is a chart of the generic plans being offered on the NY Health Benefits Exchange.
Here is the approved New york State rate chart.
If you focus on the Silver Plan, you'll not that the deductible is $2000 with a maximum out of pocket cap of $5000.
But in order to access these magnanimous benefits, if you select, say Oxford, and live in the New York City vicinity, as I do, you'll pay a monthly premium of $555.48 X 12 = $6,665.76, then you've got the $2000 deductible which brings your immediate costs to $8665.76.
Then you've got, co-pays and co-insurance on top of this. You've got to incur an additional $3000 after the deductible to hit your out-of-pocket cap.
What we're really seeing play out is an overhaul of the insurance model codified by the Affordable Care Act. It will be all but impossible (except for the mega rich), to buy insurance offering what is called first dollar coverage. This means we will all be required to pay steep premiums and deductibles but may not have the financial resources to actually access healthcare.
As I like to say, you don't have to believe me, but you should trust theJournal of General Internal Medicinewhich made exactly this point.
“Obamacare is making underinsurance the new normal,” said Woolhandler. “It will reduce the number of uninsured from 50 million to 30 million, but the new coverage is full of holes. Americans deserve the kind of first-dollar, comprehensive coverage that Canadians already have. But that’s only affordable under a single-payer system that cuts out the private insurance middlemen.”
Yes, thanks to the ACA, there are a couple of preventative screenings included in these huge costs, but overall, what we have going on here is a huge shifting of costs onto the backs of the insured.
As we all know, there is zero price transparency in the US healthcare system, so God help you if you plan on calling around to get the best price for a bypass before signing up.
And when you pay for that bypass, you'd do yourself a favor by considering getting it in a country with far better outcomes, at a fraction of the cost than in the United States.
I am reminded on days like today, that President Obama campaigned on the idea that people like me would see something like a $2500 reduction in health insurance costs.
What was I thinking?