I was paying around $1200/month last year (a little under that with subsidy).
This year I'm paying $2100/month for a family of five, on a roughly equivalent plan. Except, none of the options in my state allow me to visit the PCP I switched to this year (since none of the plans last year covered my PCP from the year before).
So I guess I'm on a primary care physician merry go round :D
I am at least able to have my main specialty doctor and the drug I take to keep me in remission from Crohn's disease, and my kids' pediatrician is covered.
But I can't imagine what people have to sacrifice to keep any kind of coverage (with high deductible and horrible coinsurance and prescription drug coverage) for their families if they don't have a decent income :(
> But I can't imagine what people have to sacrifice to keep any kind of coverage (with high deductible and horrible coinsurance and prescription drug coverage) for their families if they don't have a decent income :(
These increases are specifically a lapse in subsidies for high earners -- those with a "decent income." People under 400% of Federal Poverty Level still qualify for the subsidies. And it's a relatively recent policy change to roll back; we didn't have this subsidy from 2010-2020.
This is not specifically just a lapse in subsidies for high earners, this is for everyone which is telling how little people actually understand what will happen when the subsidies expire.
The enhanced subsidizes made it so people earning more than 400% FPL were also eligible for subsidies, but also more importantly increased the cap on how much income insurance could cost. In reality, most people would see their insurance costs double if the subsidys expired [1].
I take Remicade for UC on a monthly cadence. From $500 to now $1300/m for 2 in TX, and an added bonus of a 10% lab coPay + All kinds of fees.
I am Blessed running a good startup but I've always felt this deeply.... "But I can't imagine what people have to sacrifice to keep any kind of coverage (with high deductible and horrible coinsurance and prescription drug coverage) for their families if they don't have a decent income :("
If you're getting health insurance through your employer, that's a pretty standard price (counting both your contribution and your employer's together).
I'm probably going to be self employed for 2026 and a cheap-ish (not the cheapest, but probably below the average) plan for my family is going to be a little under $1500 / month.
It's pre-tax money, which helps a wee bit, but it is definitely expensive. If I made less money, I'd qualify for subsidies, but I don't, so that's just something that needs to be paid in full unfortunately.
My Employer sponsored supposedly nice insurance (I say supposedly because they keep being a pain in the ass for pretty much everything) is $200+ per paycheck for me and my spouse, i.e. ~$450/month. That is after my employer covers most of the cost. This stuff is ridiculous.
I’m in Germany, and for a family of four, the public healthcare system, covering my wife and my two kids costs us around 2,200€ per month. The company pays half.
A switch to a private insurance would lower the costs around half.
>Allen is herself a casualty. While she used to pay $487.50 a month, her new healthcare plan, with reduced coverage, has monthly premiums of $1,967.50.
Brutal.
Meanwhile the White House calls it all "fake news".
Quick summary: the US does not have anything approaching a modern healthcare system. (And likely will not for quite some time due to a set of structural factors.)
Obamacare (the Affordable Care Act or ACA) was an attempt to expand coverage and slow the rate of increase of costs. It did the former but less well with the latter.
One other thing the ACA did is stop the scourge of scam insurers. This is a thing where people would pay for "insurance" and then find out later that their "insurance" did not actually afford them any meaningful coverage. The ACA tried to close a set of loopholes and overall regulate the insurance market more closely.
Anybody reading this from outside the US probably lives in a place where low-cost healthcare is more accessible than it is in the US.
ObamaCare (actually the Affordable Care Act: ACA) is a band-aid solution. It's a way to at least ensure that everyone has a pathway to insurance if they have enough money. Basically, the government negotiates some plans with private insurers and makes them available to the general population.
It's subsidized, but the new budget has drastically decreased these subsidies and so the cost to enroll in the ACA is about to go up for people who want to get insurance through their marketplace.
They stripped it of most meaningful changes to get it passed. What it ended up being was kind of the worst of both worlds. A federally related marketplace for private healthcare insurance. They did however ban coverage limits on “pre-existing conditions”. Before Obamacare an insurer could whine that you had cancer before signing up and refuse to cover your cancer care.
Obamacare failed at reducing costs. It mostly focused on insurance expansion and in consumer protections, not on dealing with hospital, drug, and provider pricing structures that actually drive the spending in the US healthcare system.
Unfortunately not. It's still very broken, and next year it will be worse for a ton of people. I got AI to write a short answer for you:
> Short version: Obamacare never turned into “free primary care for everyone,” it was just a bunch of rules and subsidies bolted onto the same old private-insurance maze. It helped at the margins (more people covered, protections for pre-existing conditions), but premiums/deductibles can still go nuclear if you’re in the wrong income bracket, state, or employer situation. From an EU/Poland perspective it’s not a public health system at all, just a slightly nerfed market where you still get to roll the dice every year.
You comment sounds like snark but I understand if you don't know what Obamacare is.
(And I'm not an expert so hopefully people will correct any mistakes)
"Obamacare" was never healthcare for all. It is a GOP healthcare plan that heavily subsidizes private insurance. (Because free markets) And the current affordability crisis is the result of letting the government subsidies that help people pay for their Obamacare coverage lapse.
On a positive note: Obamacare (aka the ACA-PPP) did put some restrictions reasonable restrictions on the terrible things insurance companies used to do. For example, drop customers for "pre-existing conditions", impose lifetime payout maximums, etc.
> the previous administration thought everyone should be "temporarily" paying for her plan. Moving money from person A to person B obviously doesn't make anything cheaper
No, but it means I can't pay for a first-class ticket while someone else survives. I'll take that deal.
As a supporter of single payer(or really, anything else), I support this move. When half the nation is on subsidized healthcare they aren't so likely to care about costs.
Now, you have a lot more angry people, and hopefully that leads to real reform, because what we have now is unsustainable, even to upper middle class families.
Mine has tripled, but last year, I was actually getting some govt help. Not this year. I am fortunate to be able to afford it, but it’s just less than my mortgage.
This month is when all hell breaks loose, because people will get their first invoice at the new rate. They already know how much, but seeing it in the form of a demand, will drive it home.
Obamacare is like the NHS, in the UK. Everyone likes to bitch about it, but woe unto the politician that messes with it.
The equally insidious thing is that when they get hit with the new premium anyone who took better coverage, like a silver plan for the ACA, will likely be "forced" to downgrade to a lower (bronze) plan, which means that when they actually get services their costs will further skyrocket (higher deductibles and out of pockets).
Talking about all hell breaking loose... Marjorie Taylor Greene announces her resignation specifically because of rising health care costs (yeah, I'm cynical,there's maybe more to it). Mamdani gets elected on a platform that's essentially "shit costs too much." Maybe folks on both sides are starting to wake up. A guy can dream...
MTG just got her pension. I doubt healthcare costs have anything substantively to do with it. Someone just wants to avoid digging a hole any deeper than they have.
> Isn’t obamacare what caused all these problems in the first place?
I don’t think so, but it’s a fairly poor attempt to address the industry problems. It’s a lash-up “solution” to a problem caused by our entire healthcare structure.
> Obamacare was just a blank check to private companies
And healthcare providers. No one wants to fix the real issue, so this was the only thing all those lobbyists would allow.
That doesn’t change the fact that it has actually become quite popular.
One thing that I’ve been trying to understand about this discourse:
Is the sum of the increase in costs some people are now paying greater than the subsidies that previously existed?
In other words: was there always a massive bill to be paid here, but it was just previously socialized and hidden in the form of taxes/ public debt? Or does the act of subsidizing it actually decrease the total?
Yes to both. High costs were previously partly hidden by subsidies for some consumers purchasing individual or family policies on state ACA exchanges, and now many of them will be forced to pay something closer to the true market price. But just like with college tuition, when the government throws money at a problem that ends up causing costs to explode without permanently improving affordability.
There can be no market clearing price, because healthcare demand is unlimited.
In some countries supply is rationed by using different means such as waiting lists, budgets for funding, or even corruption (I witnessed this in Cuba).
There's a third piece too, which is that insurers are ramping price much faster than inflation. Our (unsubsidized) premiums increased 20% year-over-year, after also increasing faster than the rate of inflation the last few years.
Since premiums never decrease, one can pretty easily plot out that in the next ~decade we will see family premiums larger than the median salary. The economics of all this are going to get very weird in the near future.
That's all true, but insurers are ramping up premiums faster than inflation largely because providers have raised their prices, and utilization has greatly increased due to an aging sicker population. The ACA minimum medical loss ratio means that health plans profits aren't increasing much.
Insurer premiums are capped and rise with costs. To the extent they're rising faster than inflation, that is only possible because their costs are rising faster than inflation. Costs are rising in large part for demographic reasons -- boomers are getting older.
Year-over-year increase in GDP in the U.S. right now is almost exclusively “production” output from the healthcare industry, whose profits are stratospheric and rising. So there’s two useful datapoints here: first, the bill must be paid, or U.S. GDP growth year-over-year falters, not because healthcare costs this much; and second, household debt continues to increase year-over-year to permit continued wage stagnation. Whether insurers end up lowering their profits (and thus prices) as the subsidy expires centers around whether banks extend further debt as a household wages subsidy. As of right now, that seems to be continuing, even though some of that debt market is in the midst of a small crash, so insurers (who have no regulatory limits on profit levels) are unlikely to lower their profit targets as subsidies end.
So long as the political will of U.S. leadership supports that continued profit, and either government and/or banks subsidize worker wages to cover the increased profits, then we’ll continue seeing growth in costs on paper before subsidies. This growth in profits/prices could not be sustained on wages alone, given the continuing decline of inflation-adjusted worker earnings; and so to answer your question, yes: the act of subsidizing is what’s enabling the prices being charged; but, no: the costs of providing healthcare to any one person of a given age are not increasing due to subsidies; just the profits.
Commercial health insurers have relatively low profit margins. This is forced by the ACA minimum medical loss ratio. In theory Congress could increase that ratio slightly but it wouldn't do much to improve affordability for consumers.
The subsidies are going down, but the base price of the plans are going way up. The plan I'm on increased from $800/month to $1150/month next year, and that is a modest increase compared to most others I've heard about. I'm switching to a maybe cheaper plan - if I use less healthcare, but if I use too much it will be more expensive due to much higher deductibles.
Insurers haven't really explained why the base prices of plans are going up so much. Perhaps GLP-1 drugs but that doesn't seem like enough (those drugs often aren't covered by ACA plans anyway due to their brand-name status). It could be a delayed effect from all the inflation a couple years ago - health care contracts are negotiated on the order of years, and a bunch could have just been renegotiated to reflect current market prices.
ACA insurers are required to pay out N% of their premiums. This means that a really important way of keeping premiums down is to make sure that people who use less medical care are in the insured pool. But if somebody is looking at a $20,000 annual bill in premiums and is generally healthy they might look elsewhere than the ACA markets or just simply go uninsured. That person leaving the insured pool means that everybody else's premiums go up.
The ACA had two strategies to keep these people in the pool: the individual mandate and the subsidies trying to keep prices lower. The mandate was removed years ago. And while we still have subsidies below 400% FPL, the ones for people above 400% FPL are gone. A self-employed person making $75,000 annually who previously could afford insurance might now be looking at alternatives.
Is there a rich caste of doctors or pharmaceutical shareholders that don't need to work and live off these dividends? Or is the system so inefficient that most people in it aren't contributing to actual health care?
If you want to understand where the money is actually going then this Peter Attia Drive podcast episode with Dr. Saum Sutaria is the best high level overview that I've heard. Seriously it's worth listening to and will clear up a lot of the misconceptions that many people have.
Nearly all of it goes to grifters who hang on to the system but don't contribute anything. The obvious ones are all the insurance company employees who don't provide any healthcare, just push paperwork to try to find ways to deny coverage. And all the oberpaid administrators, and of course those multi-million bonuses to all executives involved need to be paid somehow.
If that sounds overly cynical, consider a primary care doctor visit. I get about 15 minutes of the time of a nurse assistant (some searching suggests average wage 50K) and 12 minutes with the doctor (searching suggests average wage of 250K).
So the cost of salaries to the people that actually provided me healthcare that day, is $6 + $24 = $30. Even if we double the salaries of both nurse and doctor, it'd be a $60 visit.
Of course, there's office overhead like rent, utilities, etc.
But I get billed $500 for that visit. SO where is all that money going? Obviously not to the health care professionals.
If we simply removed all the grifters from the system, health care would be quite affordable.
That does not match your earlier statement about administrators or health insurance, though. Or does your primary care doctor work in a big hospital that takes a 400% margin?
Doctors are by far the highest paid professional occupation in America. The AMA is the most powerful trade union in history and restricts the number of new doctors, pushing up prices.
Specialist doctors are one of the highest paid professions in almost all countries. There are hardly any jobs more important than those of say a heart surgeon or a neurosurgeon.
Your taxes would double, and don't even bother trying to say they wouldn't literally every country with public health care pays twice as much as we do in tax
The root cause of this is, in my opinion, that in 2009 instead of getting the Healthcare system that Obama promised, we got the one that Rahm Emanuel substituted for reasons unknown. I will never forgive Rahm for this sin.
Actually socialized medicine would give us better outcomes for less spending. Instead we have a pork barrel project that has become "too big to fail".
Eventually we'll get Medicare for all, but it'll be hell in the meanwhile.
I have some questions but I don't want to offend anybody. Aren't there any methods to contract the healthcare to lower the prices down? I heard that in UK they have some requirements that the prices must not go higher than... For a given type of service. Also I read a lot of articles that giving a tablet to a hospitalised person costs 20-50 bucks and people are generally running away from ambulances to not pay
It's a twisty maze of passages, all alike as they say. They have entire classes of certifications for understanding how medical and insurance billing works in this country.
Yep, you and your employer pay $3500/month for the premium. Then you as an individual have a $12k to $15k per year deductible before the insurance even kicks in.
It's weird to me that americans, especially educated professional americans, have become much more quiet in their online presence due to all the crisis they are facing- what we have now is pretty different
People do do that in some limited cases, but it's often impractical. Two common cases are a) there is a need for urgent/emergency care; or b) the patient is generally frail and infirm. In these cases it can be impossible or impractical to arrange for treatment outside the US. That's leaving aside the logistical difficulty of arranging it (plus the costs for travel, etc. associated with carrying out the plan).
Never, because the person who cleans your toilet cannot simply hop on a flight to Mexico every time she needs surgery. But that's also not a great solution for society, to have the software developer caste be the only ones who can afford medicine by taking an expensive vacation.
I find the US healthcare "system" to be an interesting topic. More nuanced than people think. It honestly seems like the worst way to run anything. Like I honestly cant see who its for, other than maybe US Corporations on the list of approved medical vendors. Like, putting on my "Lives in a free(ish) healthcare country" hat, it looks bonkers from that angle. But even from a more libertarian mode, the whole thing looks daft from that angle too.
The US, today, is set up very well for wealthy people. The health care system works great for them. Their doctors are amongst the best in the world. Same with the hospitals they use. The costs are manageable if not reasonable for all of those people. And you can actually go beyond health care and find that almost everything in the US is pretty high quality for wealthy people. Housing, their neighborhoods, their schools, etc. That might help explain why the system is set up the way it is. Everything cascades from there.
A mate of mine (who allegedly has decent health insurance but that seems questionable) was trying to get a simple surgical procedure done, and the quotes he received ranged from anywhere between "We cant tell you" to multiple thousands, ultimately he found a small private hospital that sorted it out for him for 700 USD.
I actually think the 700 USD price is very reasonable. But I dont care how rich you are thats a terrible consumer experience.
All of these can be great, but the class of people that make a neighborhood in "the heights" won't have dog barking, basketballs, drugs and gunshots. The people that don't live in "the heights" could decide tomorrow to no longer have those 4 things either - but they don't because - it's a different class of people.
There is no US healthcare "system" in the sense of having a cohesive entity pursuing a unified goal. It's a bunch of separate entities each pursuing their own goals, often in conflict with each other. If we were designing a healthcare system from scratch it obviously wouldn't look anything like what we have today. But we arrived here through a process that economists call "path dependence", and this makes it stubbornly resistant to systemic improvements.
Blame the misguided belief elevated to State motto that "private is always better than public". They've shoe-horned a profiteering class of parasites into an inelastic market, free to jack up prices of literally vital goods as much as they want. And the current administration, who holds much contempt for life, is perfectly happy to tear down the last poor band-aid the previous admin half-assedly put in place.
We desperately need to vastly increase the number of physicians in this country to decrease costs. The AMA is the most powerful trade union in history and has locked the number of new doctors a year for many years now. Restricting supply for a service with inelastic demand skyrockets prices and lines their pockets.
Bullshit. The AMA is a voluntary membership organization, not a trade union. They have no power to set prices or engage in collective bargaining.
The immediate bottleneck on producing more physicians is limited Medicare funding for residency slots. Every year some students graduate from medical school with an MD but are unable to practice medicine because they don't get matched to a residency program (some do get matched the following year). At one point the AMA did lobby Congress to restrict that funding but they reversed position several years back.
PE is a convenient whipping boy but it's not the main problem. There has been so much consolidation of health systems and other provider organizations in some regions that they now effectively have monopolies, allowing them to jack up prices. The effect is largely the same whether the owner is a PE firm or a non-profit foundation. In order to counteract that we would need much more vigorous antitrust enforcement, which doesn't seem politically likely.
I'm so sick of this trope. "It's the insurance companies!" "No, it's private equity!" "No, it's the PBMs!" I don't care. Jesus Christ, going to the doctor is rapidly becoming unattainable for more and more people, including the PMC now, and all of the rich people are simply pointing at each other saying "it's the other guy!".
Unpopular opinion: Evil and greedy insurers are not the biggest problem. The biggest problem is the socialized costs of sugar drinks, junk food, and sedentary life. The food industry operates like a drug cartel who starts the pipeline getting children addicted.
That combined with outrageously expensive magic pill healthcare. A situation partly caused because doctors can't tell patients they are too fat and lazy. Because feelings and hate-crime.
That’s a meaningless statement, look for an actual percentage here.
Healthcare costs have been spiraling for decades in the US, the ACA didn’t impact the long term trends to a noticeable degree. Actual healthcare reform could drive down costs massively, but that would mean a fuck load of people in medical billing getting laid off. Instead you’re paying for your doctor to talk with your insurance provider often for longer than they spend working with you, that’s the ultimate issue with US healthcare costs. Inflation adjusted “healthcare” spending is up from 2,100$/person in 1970 to 14,570 in 2023.
What did the ACA require that shouldn't be part of healthcare in one the wealthiest countries in the world?
Annual check ups? Cancer screenings? Maternity care? Basic mental health?
Forcing the insurance companies to accept patients with preexisting conditions?
These services should be available to everyone.
If a developed country cannot provide these things to its citizens it's a failing state in my book.
It would be significantly cheaper for my wife and I to have a catastrophic-coverage-only plan, but those are now illegal. Between premiums and deductibles, I think we will have to spend north of $30,000 next year before we break even and insurance actually benefits us in any way whatsoever.
You can get telehealth appointments for many things for pretty cheap via companies like GoodRx, and screenings through dedicated groups as well. My last telehealth visit (and likely my last ever) through my PCP's network charged me+my insurance $300 for a 5 minute phone call to renew a prescription I've been on for years.
ACA just solidified the health system as a quasi-private government organization with its own tax system. We could do so much better, but we're hamstrung by a feckless congress.
You don't need it until you need it, and needing it often comes in the form of a lightning strike from blue sky. The counterargument is that having everyone pay a higher amount makes it feasible to actually have this coverage available, when needed, without bankrupting the insurance companies, because the rare astronomically expensive care is covered by the premiums paid by the vast majority of people who are relatively healthy and are unlikely to need it.
Now whether the on-paper prices for medical care in this country actually have any relationship to objective reality is an entirely separate question of course. In general coming from an outside perspective, combining healthcare and for-profit motives in a single system seems particularly likely to lead to all kinds of perverse incentives, but, it's the system that exists, and it seems unlikely to change any time soon.
What I don't understand however is what IS actually expensive about the care itself?
Doc will get paid his normal rate, $500k per year (maybe more maybe less?)
Nurses all get paid something between 100k and 200k (maybe more maybe less?)
Then we hear about these surgeries that cost 100k.
What exactly is costing 100k for 5 hours of knife and time in a bed?
Wildfire, I understand, there is no way to re-materialize a house for less than (what is basically a fortune these days). But time and materials for a surgery seem to me that it should cost 5k at most?
And at those rates, wouldn't everyone just pay like $15 a month? And if the answer to this question is malpractice costs, can we have two plans:
The main point of health insurance is to cover things that most people don't need. Prior to the ACA, most health plans had lifetime coverage limits which could leave patients with serious conditions financially ruined or unable to access care. The ACA removed those limits so naturally coverage is now more expensive.
Bronze plan is shitty catastrophic insurance at like 5x the actuarial cost to try to fund risk pool and all the mandated benefits thst the o/p alluded to
Which are the specific things you think most people don't need coverage for? Prior to the ACA, it was pretty common to hear stories of people not on employer plans who were shocked to discover a coverage gap they have. Most people don't have much expertise in evaluating healthcare coverage and deciding which services they might need.
> The end result is we all have Cadillac plans that most people don't need.
That's right, those pesky things the ACA says should be covered like emergency services, ambulances and prescription drugs is definitely the issue here. You've definitely found the problem.
I can't believe people keep repeating this lie. Did no one live prior to the ACA where you could easily go bankrupt because your insurance decided it didn't cover things like hospital bills? Because I sure as fuck remember, considering that's what bankrupted my parents.
It should be mentioned that the US has very high wages, and even when subtracting substantial health care insurance cost, the income likely remains higher than what people earn in most other countries.
If you have a high paying job in the US it usually comes with legitimate health insurance paid for by your employer, meaning most of the cost of most healthcare is covered.
If you don’t you pay a lot. Before ACA non-group plans generally didn’t cover any health conditions that predated your coverage.
ACA was just good enough to cool down demands for a true public health plan while also being just shitty enough to turn everyone else off to ever wanting one. Essentially the perfect way to prevent a public option for generations.
Reading this sent me down a bit of an OECD data rabbit hole. They seem to agree. However once you read the fine print I'm not so sure. Many things are much more costly in the US (education, travel, food, vehicles, houses...) and the OECD data seems to not control for that. Also my personal experience is there are a large number of very poor people in the USA. Seems like more than in Western Europe for example.
You should go tell that to the waiters who are working for tips.
Reads a bit like you’re in a bubble. I have friends in the States who work in education, construction, and hospitality. I similarly have friends working in those fields in EU. I’d say the ones in EU are better off _and_ don’t worry about healthcare.
Not to mention you get actual vacation time in Europe and a higher standard of living generally.
Don'tcha know, the only real jobs are "software developer" and "haver of lots of money for investing in software developers". Everyone else can pay $10,000 for their surgery.
In case you are wandering where the money goes. If you need a gall bladder removed or an appendix removed the bill to you might be $10,000-30,000 but the surgeon, for all of their care and time with you, is compensated less than $100.
I'm confident a surgeon in America is paid more than 100$ for a surgery. They are paid about 400k a year on average. Do the math yourself.
On the other hand you provided no details as to where the money actually goes. It's not a simple proble, and part of the problem is that our doctors are paid a lot more than in peer nations
I did get my gall bladder removed in July, and I know paid my surgeon a lot more than a 100 bucks, which was just the smaller deductible portion of the bill.
"Healthcare administrator's growth in the US. Healthcare administrator's growth by 3200% between 1975 and 2010 compared to 150% Physician growth according to Athena Health analysis of data from Bureau of Labor Statistics, the National Center of Health Statistics, and the United States Census Bureau's Current Population survey in accordance to [26]. Admin: administration; HIPAA: Health Insurance Portability and Accountability Act; HITECH Act: Health Information Technology for Economic and Clinical Health Act; DRGs: diagnosis-related group's."
The only class of medical services that has become more affordable over the last 50 years is cosmetic procedures and laser eye surgery:
What value addition do the administrators provide? It might be helpful to understand why competing hospitals still find it useful to employ these people even if the cost is so high.
If a competing hospital can provide equivalent service while also not spending so much on an administrator, why didn't they already do it?
The administrative overhead is necessary in order to get money from the insurance companies. Without the administrators too administrate and fill out copious amounts of paperwork, the hospital won't get paid by the insurance companies, and if the hospital don't get no money, they can't pay their staff, and staff tend to like getting paid.
Answering myself, apparently it is a fight between administrators on the hospital end and the administrators on the insurance company end.
The insurance administrators are fighting to provide as less reimbursement as possible and the hospital administrators are fighting to provide as much reimbursement as possible. The administrators are probably doing compliance work, negotiations.
I wonder whether regulations can be used to cap the role of administrators at the expense of slightly less efficient market - this might work if administrators are just adversarially interacting and reducing their scope can help the overall picture.
You assume that there is any meaningful competition. What we are seeing, across industries including education, is a type of indirect collusion that is keeping prices crazy, not competition. Over regulation is a big piece of what enables all this.
I was paying around $1200/month last year (a little under that with subsidy).
This year I'm paying $2100/month for a family of five, on a roughly equivalent plan. Except, none of the options in my state allow me to visit the PCP I switched to this year (since none of the plans last year covered my PCP from the year before).
So I guess I'm on a primary care physician merry go round :D
I am at least able to have my main specialty doctor and the drug I take to keep me in remission from Crohn's disease, and my kids' pediatrician is covered.
But I can't imagine what people have to sacrifice to keep any kind of coverage (with high deductible and horrible coinsurance and prescription drug coverage) for their families if they don't have a decent income :(
> But I can't imagine what people have to sacrifice to keep any kind of coverage (with high deductible and horrible coinsurance and prescription drug coverage) for their families if they don't have a decent income :(
These increases are specifically a lapse in subsidies for high earners -- those with a "decent income." People under 400% of Federal Poverty Level still qualify for the subsidies. And it's a relatively recent policy change to roll back; we didn't have this subsidy from 2010-2020.
This is not specifically just a lapse in subsidies for high earners, this is for everyone which is telling how little people actually understand what will happen when the subsidies expire.
The enhanced subsidizes made it so people earning more than 400% FPL were also eligible for subsidies, but also more importantly increased the cap on how much income insurance could cost. In reality, most people would see their insurance costs double if the subsidys expired [1].
[1] https://www.kff.org/affordable-care-act/aca-marketplace-prem...
I'm so, so sorry to hear this. Can you share which state you're in?
My man, this is the Raspberry Pi guy, Jeff Greeling. He lives in St. Louis, MO.
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You go without coverage of course. Unfortunately.
(It's getting late, Jeff. I'm heading to bed myself.)
I take Remicade for UC on a monthly cadence. From $500 to now $1300/m for 2 in TX, and an added bonus of a 10% lab coPay + All kinds of fees.
I am Blessed running a good startup but I've always felt this deeply.... "But I can't imagine what people have to sacrifice to keep any kind of coverage (with high deductible and horrible coinsurance and prescription drug coverage) for their families if they don't have a decent income :("
my premium actually went down because my carrier left aca, but there are no longer any carriers with a decent network in the exchange.
the networks in the illinois aca suck if you live in the chicago area.
> This year I'm paying $2100/month for a family of five,
blink
Top cover in Australia for a family is about USD$400 per month.
Excuse me, but how in the world were you able to afford 1200/month, you know that's like cheap rent right?
If you're getting health insurance through your employer, that's a pretty standard price (counting both your contribution and your employer's together).
I'm probably going to be self employed for 2026 and a cheap-ish (not the cheapest, but probably below the average) plan for my family is going to be a little under $1500 / month.
It's pre-tax money, which helps a wee bit, but it is definitely expensive. If I made less money, I'd qualify for subsidies, but I don't, so that's just something that needs to be paid in full unfortunately.
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My Employer sponsored supposedly nice insurance (I say supposedly because they keep being a pain in the ass for pretty much everything) is $200+ per paycheck for me and my spouse, i.e. ~$450/month. That is after my employer covers most of the cost. This stuff is ridiculous.
That’s absolutely not an exception.
I’m in Germany, and for a family of four, the public healthcare system, covering my wife and my two kids costs us around 2,200€ per month. The company pays half.
A switch to a private insurance would lower the costs around half.
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You're still allowed to visit the same PCP although it might not be covered, or covered out-of-network with a higher patient responsibility.
>Allen is herself a casualty. While she used to pay $487.50 a month, her new healthcare plan, with reduced coverage, has monthly premiums of $1,967.50.
Brutal.
Meanwhile the White House calls it all "fake news".
> Meanwhile the White House calls it all "fake news".
The truth is a lie and only government lies are the truth. Orwell would be so proud.
Guy from Poland here. What happened to ObamaCare? I thought you got finally a primary healthcare for all?
Quick summary: the US does not have anything approaching a modern healthcare system. (And likely will not for quite some time due to a set of structural factors.)
Obamacare (the Affordable Care Act or ACA) was an attempt to expand coverage and slow the rate of increase of costs. It did the former but less well with the latter.
One other thing the ACA did is stop the scourge of scam insurers. This is a thing where people would pay for "insurance" and then find out later that their "insurance" did not actually afford them any meaningful coverage. The ACA tried to close a set of loopholes and overall regulate the insurance market more closely.
Anybody reading this from outside the US probably lives in a place where low-cost healthcare is more accessible than it is in the US.
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ObamaCare (actually the Affordable Care Act: ACA) is a band-aid solution. It's a way to at least ensure that everyone has a pathway to insurance if they have enough money. Basically, the government negotiates some plans with private insurers and makes them available to the general population.
It's subsidized, but the new budget has drastically decreased these subsidies and so the cost to enroll in the ACA is about to go up for people who want to get insurance through their marketplace.
They stripped it of most meaningful changes to get it passed. What it ended up being was kind of the worst of both worlds. A federally related marketplace for private healthcare insurance. They did however ban coverage limits on “pre-existing conditions”. Before Obamacare an insurer could whine that you had cancer before signing up and refuse to cover your cancer care.
Obamacare failed at reducing costs. It mostly focused on insurance expansion and in consumer protections, not on dealing with hospital, drug, and provider pricing structures that actually drive the spending in the US healthcare system.
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Unfortunately not. It's still very broken, and next year it will be worse for a ton of people. I got AI to write a short answer for you:
> Short version: Obamacare never turned into “free primary care for everyone,” it was just a bunch of rules and subsidies bolted onto the same old private-insurance maze. It helped at the margins (more people covered, protections for pre-existing conditions), but premiums/deductibles can still go nuclear if you’re in the wrong income bracket, state, or employer situation. From an EU/Poland perspective it’s not a public health system at all, just a slightly nerfed market where you still get to roll the dice every year.
You comment sounds like snark but I understand if you don't know what Obamacare is.
(And I'm not an expert so hopefully people will correct any mistakes)
"Obamacare" was never healthcare for all. It is a GOP healthcare plan that heavily subsidizes private insurance. (Because free markets) And the current affordability crisis is the result of letting the government subsidies that help people pay for their Obamacare coverage lapse.
On a positive note: Obamacare (aka the ACA-PPP) did put some restrictions reasonable restrictions on the terrible things insurance companies used to do. For example, drop customers for "pre-existing conditions", impose lifetime payout maximums, etc.
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It's always cost ~$2k a month, the only difference is the previous administration thought everyone else should be "temporarily" paying for her plan.
I feel like we need a perpetual PSA here that moving money from person A to person B obviously doesn't make anything cheaper.
> the previous administration thought everyone should be "temporarily" paying for her plan. Moving money from person A to person B obviously doesn't make anything cheaper
No, but it means I can't pay for a first-class ticket while someone else survives. I'll take that deal.
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As a supporter of single payer(or really, anything else), I support this move. When half the nation is on subsidized healthcare they aren't so likely to care about costs.
Now, you have a lot more angry people, and hopefully that leads to real reform, because what we have now is unsustainable, even to upper middle class families.
when the gov foots the bill, there's no reason to have competition.
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No, it definitely did not always cost $2k a month.
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Mine has tripled, but last year, I was actually getting some govt help. Not this year. I am fortunate to be able to afford it, but it’s just less than my mortgage.
This month is when all hell breaks loose, because people will get their first invoice at the new rate. They already know how much, but seeing it in the form of a demand, will drive it home.
Obamacare is like the NHS, in the UK. Everyone likes to bitch about it, but woe unto the politician that messes with it.
The equally insidious thing is that when they get hit with the new premium anyone who took better coverage, like a silver plan for the ACA, will likely be "forced" to downgrade to a lower (bronze) plan, which means that when they actually get services their costs will further skyrocket (higher deductibles and out of pockets).
Talking about all hell breaking loose... Marjorie Taylor Greene announces her resignation specifically because of rising health care costs (yeah, I'm cynical,there's maybe more to it). Mamdani gets elected on a platform that's essentially "shit costs too much." Maybe folks on both sides are starting to wake up. A guy can dream...
MTG just got her pension. I doubt healthcare costs have anything substantively to do with it. Someone just wants to avoid digging a hole any deeper than they have.
Isn’t obamacare what caused all these problems in the first place? NHS is public. Obamacare was just a blank check to private companies
> Isn’t obamacare what caused all these problems in the first place?
I don’t think so, but it’s a fairly poor attempt to address the industry problems. It’s a lash-up “solution” to a problem caused by our entire healthcare structure.
> Obamacare was just a blank check to private companies
And healthcare providers. No one wants to fix the real issue, so this was the only thing all those lobbyists would allow.
That doesn’t change the fact that it has actually become quite popular.
One thing that I’ve been trying to understand about this discourse:
Is the sum of the increase in costs some people are now paying greater than the subsidies that previously existed?
In other words: was there always a massive bill to be paid here, but it was just previously socialized and hidden in the form of taxes/ public debt? Or does the act of subsidizing it actually decrease the total?
Yes to both. High costs were previously partly hidden by subsidies for some consumers purchasing individual or family policies on state ACA exchanges, and now many of them will be forced to pay something closer to the true market price. But just like with college tuition, when the government throws money at a problem that ends up causing costs to explode without permanently improving affordability.
> true market price
There can be no market clearing price, because healthcare demand is unlimited.
In some countries supply is rationed by using different means such as waiting lists, budgets for funding, or even corruption (I witnessed this in Cuba).
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There's a third piece too, which is that insurers are ramping price much faster than inflation. Our (unsubsidized) premiums increased 20% year-over-year, after also increasing faster than the rate of inflation the last few years.
Since premiums never decrease, one can pretty easily plot out that in the next ~decade we will see family premiums larger than the median salary. The economics of all this are going to get very weird in the near future.
That's all true, but insurers are ramping up premiums faster than inflation largely because providers have raised their prices, and utilization has greatly increased due to an aging sicker population. The ACA minimum medical loss ratio means that health plans profits aren't increasing much.
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Insurer premiums are capped and rise with costs. To the extent they're rising faster than inflation, that is only possible because their costs are rising faster than inflation. Costs are rising in large part for demographic reasons -- boomers are getting older.
Year-over-year increase in GDP in the U.S. right now is almost exclusively “production” output from the healthcare industry, whose profits are stratospheric and rising. So there’s two useful datapoints here: first, the bill must be paid, or U.S. GDP growth year-over-year falters, not because healthcare costs this much; and second, household debt continues to increase year-over-year to permit continued wage stagnation. Whether insurers end up lowering their profits (and thus prices) as the subsidy expires centers around whether banks extend further debt as a household wages subsidy. As of right now, that seems to be continuing, even though some of that debt market is in the midst of a small crash, so insurers (who have no regulatory limits on profit levels) are unlikely to lower their profit targets as subsidies end.
So long as the political will of U.S. leadership supports that continued profit, and either government and/or banks subsidize worker wages to cover the increased profits, then we’ll continue seeing growth in costs on paper before subsidies. This growth in profits/prices could not be sustained on wages alone, given the continuing decline of inflation-adjusted worker earnings; and so to answer your question, yes: the act of subsidizing is what’s enabling the prices being charged; but, no: the costs of providing healthcare to any one person of a given age are not increasing due to subsidies; just the profits.
Commercial health insurers have relatively low profit margins. This is forced by the ACA minimum medical loss ratio. In theory Congress could increase that ratio slightly but it wouldn't do much to improve affordability for consumers.
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The subsidies are going down, but the base price of the plans are going way up. The plan I'm on increased from $800/month to $1150/month next year, and that is a modest increase compared to most others I've heard about. I'm switching to a maybe cheaper plan - if I use less healthcare, but if I use too much it will be more expensive due to much higher deductibles.
Insurers haven't really explained why the base prices of plans are going up so much. Perhaps GLP-1 drugs but that doesn't seem like enough (those drugs often aren't covered by ACA plans anyway due to their brand-name status). It could be a delayed effect from all the inflation a couple years ago - health care contracts are negotiated on the order of years, and a bunch could have just been renegotiated to reflect current market prices.
Yes, sort of.
ACA insurers are required to pay out N% of their premiums. This means that a really important way of keeping premiums down is to make sure that people who use less medical care are in the insured pool. But if somebody is looking at a $20,000 annual bill in premiums and is generally healthy they might look elsewhere than the ACA markets or just simply go uninsured. That person leaving the insured pool means that everybody else's premiums go up.
The ACA had two strategies to keep these people in the pool: the individual mandate and the subsidies trying to keep prices lower. The mandate was removed years ago. And while we still have subsidies below 400% FPL, the ones for people above 400% FPL are gone. A self-employed person making $75,000 annually who previously could afford insurance might now be looking at alternatives.
Where does all that money go to, though?
Is there a rich caste of doctors or pharmaceutical shareholders that don't need to work and live off these dividends? Or is the system so inefficient that most people in it aren't contributing to actual health care?
If you want to understand where the money is actually going then this Peter Attia Drive podcast episode with Dr. Saum Sutaria is the best high level overview that I've heard. Seriously it's worth listening to and will clear up a lot of the misconceptions that many people have.
https://peterattiamd.com/saumsutaria/
Both. Also there's a culture of infinite consumption of medical services.
> Where does all that money go to, though?
Nearly all of it goes to grifters who hang on to the system but don't contribute anything. The obvious ones are all the insurance company employees who don't provide any healthcare, just push paperwork to try to find ways to deny coverage. And all the oberpaid administrators, and of course those multi-million bonuses to all executives involved need to be paid somehow.
If that sounds overly cynical, consider a primary care doctor visit. I get about 15 minutes of the time of a nurse assistant (some searching suggests average wage 50K) and 12 minutes with the doctor (searching suggests average wage of 250K).
So the cost of salaries to the people that actually provided me healthcare that day, is $6 + $24 = $30. Even if we double the salaries of both nurse and doctor, it'd be a $60 visit.
Of course, there's office overhead like rent, utilities, etc.
But I get billed $500 for that visit. SO where is all that money going? Obviously not to the health care professionals.
If we simply removed all the grifters from the system, health care would be quite affordable.
> But I get billed $500 for that visit.
That does not match your earlier statement about administrators or health insurance, though. Or does your primary care doctor work in a big hospital that takes a 400% margin?
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Doctors are by far the highest paid professional occupation in America. The AMA is the most powerful trade union in history and restricts the number of new doctors, pushing up prices.
Specialist doctors are one of the highest paid professions in almost all countries. There are hardly any jobs more important than those of say a heart surgeon or a neurosurgeon.
I have changed my mind on this after looking at the data. Not much cost can be attributed to the doctors.
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Nationalize health care. Doctors should work for the government, hospitals should be owned by the government; for profit health care is a scam.
Your taxes would double, and don't even bother trying to say they wouldn't literally every country with public health care pays twice as much as we do in tax
We pay more tax for healthcare in the US than virtually anyone else. Last I looked, only Norway had us beat in terms of taxes for healthcare.
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Does it really matter if cost is in "insurance" or in tax? Wouldn't overall lower total be better?
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Even if my taxes doubled, it would be less than just the premiums on my current family health coverage.
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The root cause of this is, in my opinion, that in 2009 instead of getting the Healthcare system that Obama promised, we got the one that Rahm Emanuel substituted for reasons unknown. I will never forgive Rahm for this sin.
Actually socialized medicine would give us better outcomes for less spending. Instead we have a pork barrel project that has become "too big to fail".
Eventually we'll get Medicare for all, but it'll be hell in the meanwhile.
I have some questions but I don't want to offend anybody. Aren't there any methods to contract the healthcare to lower the prices down? I heard that in UK they have some requirements that the prices must not go higher than... For a given type of service. Also I read a lot of articles that giving a tablet to a hospitalised person costs 20-50 bucks and people are generally running away from ambulances to not pay
It's a twisty maze of passages, all alike as they say. They have entire classes of certifications for understanding how medical and insurance billing works in this country.
Japan has something to that effect. There are ways to make it happen.
Corrupt congress people will vote down any such proposals.
I read healthcare now amounts to buying a new car every year. (Except, of course, nothing new in your driveway, nothing to resell, etc.)
This is misleading.
Health insurance premiums cost about as much as buying a new car every year. Healthcare is generally on top of those premium payments.
Yep, you and your employer pay $3500/month for the premium. Then you as an individual have a $12k to $15k per year deductible before the insurance even kicks in.
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I suspect it was health insurance premiums being discussed. Thanks.
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I pay $120/mo. I don't understand. Are you including the employer paid share in this calculation?
You are lucky to have employer-provided health care.
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It's weird to me that americans, especially educated professional americans, have become much more quiet in their online presence due to all the crisis they are facing- what we have now is pretty different
At what point does it become a better financial decision to do telehealth and medical procedures completely in a different country?
Can you be health insured outside of the country you live?
People do do that in some limited cases, but it's often impractical. Two common cases are a) there is a need for urgent/emergency care; or b) the patient is generally frail and infirm. In these cases it can be impossible or impractical to arrange for treatment outside the US. That's leaving aside the logistical difficulty of arranging it (plus the costs for travel, etc. associated with carrying out the plan).
Never, because the person who cleans your toilet cannot simply hop on a flight to Mexico every time she needs surgery. But that's also not a great solution for society, to have the software developer caste be the only ones who can afford medicine by taking an expensive vacation.
Sometimes it doesn't matter about the insurance if the price is right. Medical tourism is a thing already.
Ironically, a great many people from public systems actually come here to pay for procedures they cannot get or have to wait ages for.
I'm expecting all of my early social security payment plus a bit of my spouses to pay insurance next year.
This is insane.
Yeah, it sucks living in a society where the people in power have contempt for you and your family, doesn't it.
I find the US healthcare "system" to be an interesting topic. More nuanced than people think. It honestly seems like the worst way to run anything. Like I honestly cant see who its for, other than maybe US Corporations on the list of approved medical vendors. Like, putting on my "Lives in a free(ish) healthcare country" hat, it looks bonkers from that angle. But even from a more libertarian mode, the whole thing looks daft from that angle too.
The US, today, is set up very well for wealthy people. The health care system works great for them. Their doctors are amongst the best in the world. Same with the hospitals they use. The costs are manageable if not reasonable for all of those people. And you can actually go beyond health care and find that almost everything in the US is pretty high quality for wealthy people. Housing, their neighborhoods, their schools, etc. That might help explain why the system is set up the way it is. Everything cascades from there.
A mate of mine (who allegedly has decent health insurance but that seems questionable) was trying to get a simple surgical procedure done, and the quotes he received ranged from anywhere between "We cant tell you" to multiple thousands, ultimately he found a small private hospital that sorted it out for him for 700 USD.
I actually think the 700 USD price is very reasonable. But I dont care how rich you are thats a terrible consumer experience.
> Housing, their neighborhoods, their schools
All of these can be great, but the class of people that make a neighborhood in "the heights" won't have dog barking, basketballs, drugs and gunshots. The people that don't live in "the heights" could decide tomorrow to no longer have those 4 things either - but they don't because - it's a different class of people.
There is no US healthcare "system" in the sense of having a cohesive entity pursuing a unified goal. It's a bunch of separate entities each pursuing their own goals, often in conflict with each other. If we were designing a healthcare system from scratch it obviously wouldn't look anything like what we have today. But we arrived here through a process that economists call "path dependence", and this makes it stubbornly resistant to systemic improvements.
https://en.wikipedia.org/wiki/Path_dependence
Thus the quotes, but thanks for the link about path dependance, thats a concept I have been aware of but unable to name for a long time. Lucky 10000.
Blame the misguided belief elevated to State motto that "private is always better than public". They've shoe-horned a profiteering class of parasites into an inelastic market, free to jack up prices of literally vital goods as much as they want. And the current administration, who holds much contempt for life, is perfectly happy to tear down the last poor band-aid the previous admin half-assedly put in place.
I am honestly convinced a purely private system would work better than the weird situation in the US.
I am also convinced likewise that a more public system would also work better than the weird situation in the US.
If you want to know whom US healthcare is for, look at who makes the most money from it. There's your answer.
>other than maybe US Corporations on the list of approved medical vendors.
Think I hung a lantern on that
stopped buying insurance when the co-pays became unaffordable
and you never find a real doctor anymore anyway
We desperately need to vastly increase the number of physicians in this country to decrease costs. The AMA is the most powerful trade union in history and has locked the number of new doctors a year for many years now. Restricting supply for a service with inelastic demand skyrockets prices and lines their pockets.
Bullshit. The AMA is a voluntary membership organization, not a trade union. They have no power to set prices or engage in collective bargaining.
The immediate bottleneck on producing more physicians is limited Medicare funding for residency slots. Every year some students graduate from medical school with an MD but are unable to practice medicine because they don't get matched to a residency program (some do get matched the following year). At one point the AMA did lobby Congress to restrict that funding but they reversed position several years back.
https://savegme.org/
Who lobbies for the regulations that limit funding for residency and have these ridiculous regulations to start with?
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> At one point the AMA did lobby Congress to restrict that funding but they reversed position several years back.
Yes, this is one of the cartel/union-like behaviors people complain about with the AMA.
There are more examples: https://petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-p...
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Private equity should be banned from healthcare.
What could go wrong putting a bunch of finance bros at the wheel of a "Pay this amount or suffer/die" industry?
PE is a convenient whipping boy but it's not the main problem. There has been so much consolidation of health systems and other provider organizations in some regions that they now effectively have monopolies, allowing them to jack up prices. The effect is largely the same whether the owner is a PE firm or a non-profit foundation. In order to counteract that we would need much more vigorous antitrust enforcement, which doesn't seem politically likely.
Isn’t it fair to argue that it’s PE doing all this consolidation?
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I'm so sick of this trope. "It's the insurance companies!" "No, it's private equity!" "No, it's the PBMs!" I don't care. Jesus Christ, going to the doctor is rapidly becoming unattainable for more and more people, including the PMC now, and all of the rich people are simply pointing at each other saying "it's the other guy!".
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Unpopular opinion: Evil and greedy insurers are not the biggest problem. The biggest problem is the socialized costs of sugar drinks, junk food, and sedentary life. The food industry operates like a drug cartel who starts the pipeline getting children addicted.
That combined with outrageously expensive magic pill healthcare. A situation partly caused because doctors can't tell patients they are too fat and lazy. Because feelings and hate-crime.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7524435/ (I think their 27% figure is way too conservative)
It's like the worst possible combination of free market capitalism/libertarianism with social liberalism.
https://archive.is/UwqzL
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> laundry list of
That’s a meaningless statement, look for an actual percentage here.
Healthcare costs have been spiraling for decades in the US, the ACA didn’t impact the long term trends to a noticeable degree. Actual healthcare reform could drive down costs massively, but that would mean a fuck load of people in medical billing getting laid off. Instead you’re paying for your doctor to talk with your insurance provider often for longer than they spend working with you, that’s the ultimate issue with US healthcare costs. Inflation adjusted “healthcare” spending is up from 2,100$/person in 1970 to 14,570 in 2023.
https://www.healthsystemtracker.org/chart-collection/u-s-spe...
What did the ACA require that shouldn't be part of healthcare in one the wealthiest countries in the world?
Annual check ups? Cancer screenings? Maternity care? Basic mental health? Forcing the insurance companies to accept patients with preexisting conditions?
These services should be available to everyone.
If a developed country cannot provide these things to its citizens it's a failing state in my book.
It would be significantly cheaper for my wife and I to have a catastrophic-coverage-only plan, but those are now illegal. Between premiums and deductibles, I think we will have to spend north of $30,000 next year before we break even and insurance actually benefits us in any way whatsoever.
You can get telehealth appointments for many things for pretty cheap via companies like GoodRx, and screenings through dedicated groups as well. My last telehealth visit (and likely my last ever) through my PCP's network charged me+my insurance $300 for a 5 minute phone call to renew a prescription I've been on for years.
ACA just solidified the health system as a quasi-private government organization with its own tax system. We could do so much better, but we're hamstrung by a feckless congress.
"ACA required stuff" is a fox news talking point.
You don't need it until you need it, and needing it often comes in the form of a lightning strike from blue sky. The counterargument is that having everyone pay a higher amount makes it feasible to actually have this coverage available, when needed, without bankrupting the insurance companies, because the rare astronomically expensive care is covered by the premiums paid by the vast majority of people who are relatively healthy and are unlikely to need it.
Now whether the on-paper prices for medical care in this country actually have any relationship to objective reality is an entirely separate question of course. In general coming from an outside perspective, combining healthcare and for-profit motives in a single system seems particularly likely to lead to all kinds of perverse incentives, but, it's the system that exists, and it seems unlikely to change any time soon.
What I don't understand however is what IS actually expensive about the care itself?
Doc will get paid his normal rate, $500k per year (maybe more maybe less?) Nurses all get paid something between 100k and 200k (maybe more maybe less?)
Then we hear about these surgeries that cost 100k.
What exactly is costing 100k for 5 hours of knife and time in a bed?
Wildfire, I understand, there is no way to re-materialize a house for less than (what is basically a fortune these days). But time and materials for a surgery seem to me that it should cost 5k at most?
And at those rates, wouldn't everyone just pay like $15 a month? And if the answer to this question is malpractice costs, can we have two plans:
I trust you doc: $15 / month
I might sue the doc after: $1500 / month
That’s how insurance works. You pay for a plan you likely don’t need so everyone older than you is reasonably covered.
If young people elected to get a barebones plan while in good health, who would subsidize them when they grow older?
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The main point of health insurance is to cover things that most people don't need. Prior to the ACA, most health plans had lifetime coverage limits which could leave patients with serious conditions financially ruined or unable to access care. The ACA removed those limits so naturally coverage is now more expensive.
Have you been on an ACA bronze plan? I wouldn’t consider it a Cadillac plan nor did I find it covering lots of unnecessary things.
Bronze plan is shitty catastrophic insurance at like 5x the actuarial cost to try to fund risk pool and all the mandated benefits thst the o/p alluded to
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This is factually incorrect and in fact the opposite of what a Cadillac plan means.
Obamacare plans are actually the opposite: they are high deductible with limited networks.
Obamacare plans typically have deductibles between $5,000 to $9,000, with a narrow selection of networks, and high premiums if unsubsidized.
This is the opposite of what a a Cadillac plan is (or used to be).
Which are the specific things you think most people don't need coverage for? Prior to the ACA, it was pretty common to hear stories of people not on employer plans who were shocked to discover a coverage gap they have. Most people don't have much expertise in evaluating healthcare coverage and deciding which services they might need.
In California, apparently acupuncture is required to be covered. I’d be happy to give up my acupuncture coverage for a lower premium. https://www.fiercehealthcare.com/payer/states-essential-bene...
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> The end result is we all have Cadillac plans that most people don't need.
That's right, those pesky things the ACA says should be covered like emergency services, ambulances and prescription drugs is definitely the issue here. You've definitely found the problem.
I can't believe people keep repeating this lie. Did no one live prior to the ACA where you could easily go bankrupt because your insurance decided it didn't cover things like hospital bills? Because I sure as fuck remember, considering that's what bankrupted my parents.
It should be mentioned that the US has very high wages, and even when subtracting substantial health care insurance cost, the income likely remains higher than what people earn in most other countries.
If you have a high paying job in the US it usually comes with legitimate health insurance paid for by your employer, meaning most of the cost of most healthcare is covered.
If you don’t you pay a lot. Before ACA non-group plans generally didn’t cover any health conditions that predated your coverage.
ACA was just good enough to cool down demands for a true public health plan while also being just shitty enough to turn everyone else off to ever wanting one. Essentially the perfect way to prevent a public option for generations.
Reading this sent me down a bit of an OECD data rabbit hole. They seem to agree. However once you read the fine print I'm not so sure. Many things are much more costly in the US (education, travel, food, vehicles, houses...) and the OECD data seems to not control for that. Also my personal experience is there are a large number of very poor people in the USA. Seems like more than in Western Europe for example.
People spend more on travel, food, and vehicles because they are richer.
You should go tell that to the waiters who are working for tips.
Reads a bit like you’re in a bubble. I have friends in the States who work in education, construction, and hospitality. I similarly have friends working in those fields in EU. I’d say the ones in EU are better off _and_ don’t worry about healthcare.
Not to mention you get actual vacation time in Europe and a higher standard of living generally.
Don'tcha know, the only real jobs are "software developer" and "haver of lots of money for investing in software developers". Everyone else can pay $10,000 for their surgery.
yes, but the people in europe aren't free(tm) /s
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In case you are wandering where the money goes. If you need a gall bladder removed or an appendix removed the bill to you might be $10,000-30,000 but the surgeon, for all of their care and time with you, is compensated less than $100.
It’s actually about $600 just for the surgery. It’s about 10 RVUs x $60 per RVU. You add some RVU modifiers to get it to about $1000.
Your point still stands, but it’s still a bit more than $100
Source: I’m a MD
I'm confident a surgeon in America is paid more than 100$ for a surgery. They are paid about 400k a year on average. Do the math yourself.
On the other hand you provided no details as to where the money actually goes. It's not a simple proble, and part of the problem is that our doctors are paid a lot more than in peer nations
I did get my gall bladder removed in July, and I know paid my surgeon a lot more than a 100 bucks, which was just the smaller deductible portion of the bill.
Bullshit. Even Medicare will pay a surgeon about $600 for CPT code 44970 and commercial health plans are higher than that.
The root cause:
https://www.researchgate.net/figure/Healthcare-administrator...
"Healthcare administrator's growth in the US. Healthcare administrator's growth by 3200% between 1975 and 2010 compared to 150% Physician growth according to Athena Health analysis of data from Bureau of Labor Statistics, the National Center of Health Statistics, and the United States Census Bureau's Current Population survey in accordance to [26]. Admin: administration; HIPAA: Health Insurance Portability and Accountability Act; HITECH Act: Health Information Technology for Economic and Clinical Health Act; DRGs: diagnosis-related group's."
The only class of medical services that has become more affordable over the last 50 years is cosmetic procedures and laser eye surgery:
https://healthblog.ncpathinktank.org/why-cant-the-market-for...
What value addition do the administrators provide? It might be helpful to understand why competing hospitals still find it useful to employ these people even if the cost is so high.
If a competing hospital can provide equivalent service while also not spending so much on an administrator, why didn't they already do it?
The administrative overhead is necessary in order to get money from the insurance companies. Without the administrators too administrate and fill out copious amounts of paperwork, the hospital won't get paid by the insurance companies, and if the hospital don't get no money, they can't pay their staff, and staff tend to like getting paid.
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Answering myself, apparently it is a fight between administrators on the hospital end and the administrators on the insurance company end.
The insurance administrators are fighting to provide as less reimbursement as possible and the hospital administrators are fighting to provide as much reimbursement as possible. The administrators are probably doing compliance work, negotiations.
I wonder whether regulations can be used to cap the role of administrators at the expense of slightly less efficient market - this might work if administrators are just adversarially interacting and reducing their scope can help the overall picture.
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You assume that there is any meaningful competition. What we are seeing, across industries including education, is a type of indirect collusion that is keeping prices crazy, not competition. Over regulation is a big piece of what enables all this.
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