I typically don\u2019t wade into this one because, to be honest, I have no idea what the solution is. \u00a0The United States is unlike any other nation. \u00a0The third largest population on earth. \u00a0A wildly diverse citizenry from scores of backgrounds. \u00a0A Democratic Republic established on the cooperation of individual states for common cause. A strong emphasis on liberty and freedom.<\/p>\n
However we fix the healthcare problem, I\u2019m sure it won\u2019t look like any other country\u2019s solution. \u00a0Likewise, when the day comes that we do cease to be the nation we were, when we collapse you might say, I\u2019m sure it won\u2019t look like any other civilization\u2019s collapse either. But that\u2019s for a different post.<\/p>\n
Healthcare. \u00a0I\u2019m no expert. \u00a0But the problem isn\u2019t our healthcare system itself. \u00a0We have relatively good healthcare. \u00a0So far at least, we\u2019re where people from around the world come to be treated. \u00a0Even our good neighbors up north have been known to vacation in the US for the odd medical procedure. \u00a0So it\u2019s not the actual healthcare that is the problem.<\/p>\n
It\u2019s not necessarily accessibility. \u00a0Though reports that you are guaranteed a right to treatment no matter what are greatly exaggerated. \u00a0It\u2019s true that no hospital can turn you away in an emergency. \u00a0That doesn\u2019t mean hospitals, or private practitioners, are obliged to take you in as a patient and set up routine treatments. \u00a0In fact, the problem there is that they are only obliged to take care of you after the emergency has happened. \u00a0And by then, it\u2019s either too late or going to be crazy expensive.<\/p>\n
Which leads to the problem. \u00a0The problem is the cost. \u00a0The out of pocket cost to the individual. \u00a0Obamacare really didn\u2019t solve that as much as it transferred the problem to the government. \u00a0The out of pocket costs were still based on what quality of package you chose which, of course, was based on how much you were willing to pay. \u00a0And that\u2019s the problem, whether it\u2019s the private sector or the government.<\/p>\n
By out of pocket, I mean of course the money you yourself pay out for a procedure. \u00a0Whether going to the doctor, getting a test done at an outpatient facility, going to the ER, whatever. \u00a0It also means, if you want, the premiums, or the price, that you pay to have the plan in the first place. \u00a0Plans come usually in two basic forms: plans through a company you work for, and plans you can buy on your own.<\/p>\n
In most cases, companies that offer a plan will pay for part of the premium, while you pay for the other. \u00a0Often the premiums are a little better through a company, as is\u00a0the coverage you get, since it follows the \u2018bulk purchase\u2019 philosophy of less for each unit the more you buy. \u00a0Buying individual plans outside of your employer will typically cost more for coverage that is not nearly as good. \u00a0Sometimes the cost can be close to double, or even more, the cost compared to cost through a company. \u00a0 This doesn\u2019t get into issues like pre-existing conditions, which were taken care of by the ACA.<\/p>\n
Then you have the real kickers that have become the big issue. \u00a0The coinsurance and deductibles. \u00a0While there are still some plans out there that follow the old PPO or HMO model of copays with 100% coverage afterward, more and more are going back to the coinsurance model. \u00a0The difference is how much you will pay from your own bank account. \u00a0Copays were nice, you paid X amount up front, say $10.00 at a doctor\u2019s office, or $50.00 at an ER. \u00a0Insurance paid everything else.<\/p>\n
Coinsurance, on the other hand, usually has you pay a certain percentage of every procedure. \u00a0So instead of $10.00 at the doctor\u2019s office, you pay 20% of the bill. \u00a0If the total cost of the visit is $100.00, under the copay you will pay $10.00. \u00a0If the doctor\u2019s visit, owing to this or that test or blood work, ends up being $200.00, you still pay $10.00. \u00a0Under coinsurance, however, you would pay $20.00 in the first example, a whopping $40.00 in the second.<\/p>\n
And when you get into hospital stays or ER visits, or certain tests like colonoscopies or X-Rays or MRIs, that can make a huge difference. \u00a0Some basic visits to the hospital can run $4000.00 to $6,000.00 just for getting a ten minute test. \u00a0Actually being admitted? \u00a0It can run into the tens of thousands. \u00a0And 20% (which is most coinsurance rates, though a minority will have 10% for\u00a0the patient responsibility) will run you high amounts quickly if the total hospital stay is, say, $16,000.00. \u00a0That\u2019s you owing $3,200.00 for the mathematically challenged.<\/p>\n
Now, most insurance companies will have an \u2018Out of Pocket Max\u2019. \u00a0That is, you won\u2019t have to pay more than X in a year. \u00a0Usually that is linked to the deductible amount. \u00a0The deductible? \u00a0You know what that is. \u00a0That\u2019s how much you have to pay straight up before the coinsurance (and in some cases and plans, the coverage from copay plans as well) kicks in. \u00a0As recently as the late 90s, most deductibles were around $500.00. \u00a0Some were $200.00. \u00a0Sometimes $100.00. \u00a0On rare occasion, the really bad plans could be upwards of $1000.00.<\/p>\n
Today, the typical\u00a0deducible is around $2500.00. \u00a0$5000.00 deductibles are not unheard of. \u00a0I\u2019ve heard some cases of $10,000.00 deductibles for catastrophic level coverage. \u00a0That is, you would have to pay $5000.00 or even $10,000.00 out of your own bank account, your own wallet so to speak, before the first brass farthing from the insurance kicked in. \u00a0And then, if you have coinsurance, the company will still only pay 80% of the remaining cost. You\u2019ll pay the other 20%.<\/p>\n
So, to an example. \u00a0You have a family of 4 let\u2019s say. \u00a0You have a plan that has $3,500 per person deductible at 80\/20 coinsurance. \u00a0Being a $3,500.00 deductible, you\u2019ll likely have an out of pocket maximum of around $6,000.00 to $7,000.00 per person. \u00a0That\u2019s how much \u2013 in each year \u2013 you\u2019ll have to spend yourself. \u00a0Per person. \u00a0It costs you $200.00 month to have, because you get it through your employer. \u00a0It could be double or triple that for private care, but let\u2019s keep it through your employer. \u00a0It may have an option for a free well check every year, or in some cases, will have a $10.00 copay for doctor\u2019s visits, but everything else is coinsurance.<\/p>\n
So right away, you\u2019re going to pay $2,400.00\/year just to have the insurance. \u00a0It\u2019s also important to remember that this is per person. \u00a0So it\u2019s $3,500.00 per person. \u00a0In most cases, there will be a \u2018Family Maximum Out of Pocket\u2019, usually around 2.5 to 3 times any one out of pocket maximum for individuals. \u00a0So in this case, it might be around $12,000.00 to $14,000.00 Out of Pocket maximum for a whole year for the family.<\/p>\n
So you\u2019re paying $2,400.00 every year just to have this. \u00a0Then, you\u2019re going to pay for, well, everything 100% up to the first 3500.00 per person. \u00a0 After that, you\u2019ll pay 20% of everything else. \u00a0Only unless you or one of your family members ends up with open heart surgery or a brain transplant will you likely cross the Out of Pocket maximum. \u00a0You may not even breach the deductible. \u00a0It is\u00a0plausible that within a given year, you don\u2019t\u00a0go past the deductibles.<\/p>\n
So at the end of the year, if any two of your family members need any type of testing or hospital based procedure, you\u2019re looking at up to $7,000.00 out of your own pocket. \u00a0In addition to the $2,400.00 you paid to have the coverage in the first place. \u00a0 That\u2019s almost $10,000.00 out of your own pocket. \u00a0If you end up getting coverage to kick in, you\u2019ll be spending more. \u00a0For your average schmuck Americans, lower middle class to middle class, that could end up being 20% or more of their entire annual income (the avg. income today is $52,000\/year, which would make our example approx. 19% of the average annual income).<\/p>\n
And it all starts over the following year. \u00a0Which could mean this scenario plays out multiple times over the course of raising a family. And not because they have no insurance, but because of the insurance they have. \u00a0And with kids, you know as well as I do it\u2019s not stretching the imagination that there will be more than one year\u00a0where you easily cap off the deductibles. \u00a0And yet in all of this, that insurance company you\u2019ve been paying hasn\u2019t had to cough up a red cent.<\/p>\n
That is the problem. \u00a0What other industry is there where you have to pay for a service it routinely avoids providing? \u00a0I know that insurance is based on Risk. \u00a0That is, I pay for it in the hopes of never using it. \u00a0And the company insures me in the hopes that it never has to pay. \u00a0But something went terribly wrong with this system. \u00a0 Somewhere, some how, the machine broke down. \u00a0And it isn\u2019t lack of healthcare, or lack of insurance availability. \u00a0It\u2019s the cost that you end up paying\u00a0even when you have the insurance and the fact that, in millions of cases a year, the insurance has to pay little to nothing. \u00a0That is the problem. \u00a0A problem no particular policy proposal, as far as I can tell, has solved.<\/p>\n
Well that ended up being longer than I planned. \u00a0And I didn\u2019t even get to my ideas of why it happened or what to do. \u00a0That will be some other time. \u00a0I just figured some numbers needed kicked around, if for nobody else than me. \u00a0That way I get the problem. \u00a0The problem is we need insurance that won\u2019t cause a vast number of Americans to go bankrupt if they end up using it. \u00a0And simply moving it from the private sector to the government or back won\u2019t solve the problem. \u00a0A middle class family stuck with multiple years of $10,000.00 in out of pocket expenses is equally bad off whether private plan or ACA.<\/p>\n<\/body><\/html>\n","protected":false},"excerpt":{"rendered":"
I typically don\u2019t wade into this one because, to be honest, I have no idea what the solution is. \u00a0The United States is unlike any other nation. \u00a0The third largest population on earth. \u00a0A wildly diverse citizenry from scores of backgrounds. \u00a0A Democratic Republic established on the cooperation of individual states for common cause. A […]<\/p>\n","protected":false},"author":2805,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[30,14],"tags":[3],"class_list":["post-8975","post","type-post","status-publish","format-standard","hentry","category-current-events","category-musings","tag-current-events"],"yoast_head":"\n