Healthcare Reform

I can speak from experience about the affect the Affordable Care Act has had on me.  As one who is self employed, my insurance premium continually rose from $142/month for a PPO plan with a $500-$1000 deductible in 2012 to an unaffordable high of $2039/month in 2019 for a similar plan with a much higher deductible and out of pocket maximum.  I ended up having to switch to an HMO plan in 2019 which reduced my premium to "only" $1173/month.  So my premium rose a whopping 828% over that time for less coverage!  It has since dropped a little to $831/month for 2023 but with a $3,000 deductible. 

 

 Also during this time, my primary care physician who I'd been seeing for almost 30 years decided to join a "VIP" practice in 2014 where patients would now be charged an annual fee of $2,000-$3000/year just for the privilege of seeing him.  This fee was not insurance, not tax deductible, and provided no tangible benefit other than guaranteeing timely appointments and more personalized attention.  My take was that my physician decided he wasn't going to be able to sustain his current practice with the restrictions under the Affordable Care Act unless he dramatically increased his patient load which would decrease treatment quality, so needed to charge an annual subsidy to maintain quality with fewer patients.  I wasn't able to afford this extra fee so, so much for being able to keep my doctor as promised by Obama.  I am now on my third primary care physician since then as the first one I signed up with retired after about a year and the second no longer took my insurance after about a year or so with him.

 

In general, I'm not opposed to paying higher premiums if it means that people with preexisting conditions can get the insurance coverage they need at an affordable rate, and it sounds like that is happening.  But what concerns me is the dramatic increase in deductibles that may be deterring many from seeking healthcare until a more serious and expensive health condition develops, resulting in self-defeating increases in healthcare costs.  Below is a chart showing the increase in insurance premiums and deductibles as a percentage of median income over time as the Affordable Care Act kicked in.  (https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/state-trends-employer-premiums-deductibles-2010-2019)

 

 

 

 

 

 

 

 

 

 

 

 

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My other concern is the increased wait times we are now experiencing to see a doctor, especially a specialist.  30-day wait times are now becoming quite common.  (https://www.businessinsider.com/americans-everywhere-are-waiting-longer-to-see-a-doctor-2022-10?op=1)

 

A few additional thoughts I have are:

• I would eliminate the requirement for health insurance companies to provide free birth control products, unless such measures were required to treat a legitimate condition unrelated to birth control.  The use of birth control is controversial and should be a personal decision.  It is well known that free birth control leads to increased sexual promiscuity which is not it our society's best interests and therefore our society should have no obligation to facilitate such behavior. 

• I would like to investigate some kind of model that includes public funding or a public-private partnership for the development of new drugs for rare (and unprofitable) diseases as well help reduce the prices of newly developed treatments.  There seems to be lots of stories these days about pharmaceutical companies inexplicably and exorbitantly raising prices on long-established medicines or charging tens of thousands of dollars a month for life-saving drugs that may or may not be covered by insurance.   We also need to revitalize the drug manufacturing capabilities within our own country.  Outsourcing the production of critical medicines to countries like China is a huge mistake.  But I admittedly have not done enough research on these topics to make any specific proposals at this time.

• Considering that many policies now have very high deductibles, we need to look at requiring physicians, hospitals, and/or insurance companies to publicly disclose costs for at a minimum, common services and treatments.  Personally speaking, when attempting to price shop for a common medical need, all I ever get are the "it depends, it's complicated," or worse, "don't worry, your insurance will pay for it" responses.  To the latter I have to say, "No, I'm paying for it because I have a high deductible!"  We need to do better.

• I would eliminate the requirement for people to repay an Obamacare subsidy should they exceed a certain earnings threshold in a particular calendar year as it requires clairvoyance to know how much money they end up making that year.  This rule not only incentivizes people to "stay poor" so they can keep their healthcare, but also could lead to financial ruin for those who should exceed that earnings threshold as the subsidy repayment requirement could literally consume the majority of any extra money earned that has likely been already spent i.e. one could end up with a multi-thousand dollar bill at the end of the year that they didn't plan on or can afford because they worked too much.  At a minimum, the previous year's earnings should be used to guide the next year's subsidy but on a phased-in schedule so as to encourage increased employment.  (This is also covered in my "Tax Reform" section.)