Reply #272: My response

[Phoebe Loosinhouse]

My objection to healthcare reform has always been, plain and simple - AFFORDABILITY. This is a word that the Congress and Senate simply cannot fathom. They have no idea of the world the average American, earning the average salary lives in.

Lets go to the Kaiser Family Health Subsidy calculator for healthcare so you can see what I am talking about. Remember that the median income in the US is approx 52,000. I plugged in for the calculation a family of 4, primary policy holder 45, income 52,000
area cost factor medium
http://healthreform.kff.org/SubsidyCalculator.aspx

Results
Note: Subsidies are only available for people purchasing coverage on their own in the Exchange (not through an employer). All individuals and families with incomes at or below 133% of the federal poverty level will be eligible for Medicaid. Others with higher incomes may also be eligible, depending on rules that vary by state.

Projected income in 2014
222% of poverty

52,000

Unsubsidized health insurance premium in 2014 adjusted for age
(Based on an age factor relative to a 40 year-old of: 1.17)

14,245

Maximum % of income the person/family has to pay for the premium if eligable for a subsidy
Actual person/family required premium payment
(which equals 7.07% of income and covers 26% of the overall premium)
3,676

Government tax credit
(which covers 74% of the overall premium)

10,569

Out-of-Pocket Costs
The maximum out-of-pocket costs the person/family will be responsible for in 2014 (not including the premium) is $6,250. Whether a person or family reaches this maximum level will depend on the amount of health care services they use. Currently, about one in four people use no health care services in any given year.

The guaranteed plan for the person/family will have an actuarial value of 73%. This means that for all enrollees in a typical population, the plan will pay for 73% of expenses in total for covered benefits, with enrollees responsible for the rest. Specific provisions like deductibles and copayments may vary from plan to plan, and out-of-pocket costs for any given individual or family will depend on their health care expenses. Preventive services will be covered with no cost sharing required.

Points to ponder

family of 4, average income of 52, buying insurance on the exchange because they don't have employer provided. Let's assume they have a sick family member and actually have to use (gasp!) the insurance
Simple arithmetic

3,676 for premium + 6,250 max out of pocket = 9926= 19% of gross income

We are not even addressing the 27% of the medical costs they are still responsible for with a coverage actuarial of 73%. Remember that in SICKO, everyone going bankrupt HAD insurance.

This family would have gone bankrupt before healthcare reform and they will go bankrupt after healthcare reform. I don't care how many CBO graphs or Commonwealth articles you show me.

Here is some further reading from the California Nurses Association:

http://www.guaranteedhealthcare.org/blog/john-geyman-md-pnhp/2010/07/08/hijacked%E2%80%94stolen-health-care-reform-why-health-care-costs-will-no

HIJACKED—STOLEN HEALTH CARE REFORM: WHY HEALTH CARE COSTS WILL NOT BE CONTAINED
Posted by John Geyman MD PNHP on July 8, 2010 - 12:51pm

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CONTINUED UNRESTRAINED DRIVERS OF HEALTH CARE COSTS
These are some of the many reasons that we can already conclude that health care costs will continue to run out of control at rates far exceeding the costs of living and median household incomes.

• No price controls. Wall Street has already factored in rapid expansion of
markets for drugs, medical devices and other services in a system of expanded
access. There is also a long line forming of providers of information technology
and administrative services that will exploit the complex implementation of this
law.


• No bulk purchasing. The PPACA has prohibited the government from
negotiating the prices of prescription drugs and retains a ban on importation of
drugs from Canada and other countries.


• Lack of control over perverse incentives that drive increased volume of
services. These in turn are driven by retention of fee-for-service (FFS)
reimbursement that encourages physicians and other providers to offer more
services than are medically appropriate or necessary.


• No effective mechanism to rein in marginal or ineffective technologies. Coverage policies for new drugs and medical devices are still lax and not subject to rigorous evidence-based criteria for either efficacy or cost-effectiveness.
Although the PPACA does call for a Patient-Centered Outcomes Research Institute, its role is already neutered by not having the power to mandate or even endorse coverage or reimbursement rules for any particular treatment. (2) (Kaiser Health News staff. True or false: Seven concerns about the new health law, March 31, 2010)

• The dominant business model of health care prevails, with many facilities and
services remaining for-profit and investor-owned and with an ongoing trend for
increasing consolidation within industries.


• The PPACA has grandfathered-in specialty hospitals, typically physician-
owned facilities that focus on well-reimbursed procedures in such areas as
cardiology and orthopedics, whereby physicians can “triple dip”, earning high
incomes as providers, owners and investors.

• More preventive services will further fuel health care inflation. While the
PPACA does provide new coverage for many preventive services, this will lead to
increased costs due to additional diagnostic and treatment services engendered.
(3) (Russell, L. Preventing chronic disease: An important investment, but don’t
count on cost savings. Health Affairs 28 (1): 42-5, 2009)


• Private insurers can’t contain health care costs, even where they have
dominant market power. A 2009 report by the Congressional Research Service,
The Market Structure of the Health Insurance Industry, concludes that “The
exercise of market power by firms in concentrated markets generally leads to
higher prices and reduced output—high premiums and limited access to health
insurance—combined with high profits.” (4) (Austin, DA, Hungerford, TL. The
Market Structure of the Health Insurance Industry. Washington, D.C.
Congressional Research Service, November 17, 2009)


• There are no controls over premium rate increases by insurers. Despite the
outcry by government officials, annual premium rates are escalating at rates up to
56 percent (5) (Johnson, A. Fight over health-care premiums heats up. Wall Street
Journal, February 19, 2010: A6), and there is no end in sight for continued
exorbitant rate increases. Insurers will continue to game the system by extracting
maximal profits and offering reduced coverage with actuarial values (the amounts
insurers actually pay in coverage) as low as 60 or 70 percent.

• National health care spending will grow unabated despite the passage of
PPACA. The Centers for Medicare and Medicaid Services (CMS) projects that
overall national health expenditures (NHE) will increase from its present 17
percent of GDP to 21 percent in 2019, a total of $4.470 trillion. (6) (Foster, RS.
Office of the Actuary. Estimated financial effects of the “Patient Protection and
Affordable Care Act,” as Amended. Centers for Medicare and Medicaid Services,
April 22, 2010)

These well-documented trends leave no room to think that health care “reform” will have any chance to contain health care costs. Instead, health care inflation will be exacerbated by all the new incentives and inefficiencies in the new “system”.

When I talked about what the rest of the world has for healthcare and their perception of us, you posted a link to an editorial from the Guardian which congratulated President Obama on his POLITICAL VICTORY, the substance had nothing to do with the quality of the bill passed.

Here is just a little reminder of the kind of healthcare available in the parts of the world where they are not so driven to preserve the private delivery system.

http://www.democraticunderground.com/discuss/duboard.php?az=show_topic&forum=389&topic_id=5736222

Charts, graphs, grey boxes, self-congratulatory pats on the back for a political victory all leave me cold. What I wanted AND STILL WANT is AFFORDABLE HEALTHCARE FOR EVERY SINGLE AMERICAN whether they are young, old, sick, or well.