When “Affordable” ain’t

Before Obamacare became law, my employer offered three plans: HMO, PPO and High Deductible Health Plan (HDHP). I opted for PPO, which had a combined deductible/copay/coinsurance of $1000/year per person.

The year the act became law, HMO and PPO options were taken off the table, and we were offered the option of HDHP, which had a combined deductible/copay/coinsurance of $5000/year per person. They took great care in repeatedly telling us that this decision had nothing to do with Obamacare, but was to do with “the higher costs of health insurance”, while ignoring the fact that the single biggest changes in the the cost of healthcare was the increased costs to health Insurance mandated by the new law.

“Pull the other one, it’s got bells on it”.

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My lady has multiple allergies and several other health issues, which require several expensive (up to $300/month *each*) drugs. Before Obamacare, I had to find $1000/year to pay for these. At about the cost of a high-end cellphone plan, this was annoying, but bearable. Under HDHP, however, I paid the first $2500 of all medical costs – which we usually burned through by March – and then 20% of all subsequent costs until we had spent another $2500, which happened around September. For the last three months of the year, however, all health costs were covered at 100%.

This led to an interesting interlude a few years ago: I was picking up her drugs and when the pharmacist told me that there was no charge, the fellow behind me said “Free drugs? How do I get some of that?“. I riposted with: “Easy. Just spend five thousand dollars“, to which he replied “Forget I asked.”.

So for me, Obamacare translates directly to a four-thousand-dollar-per-year pay cut – and that’s just for her; if I get sick, that’s another five grand I’ll have to find. this is why I flatly refuse to refer to it as the “Affordable Care Act.” I think it’s the height of understatement to say that I’m not a fan.

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Obamacare is not all bad news; two good things came out of it were The removal of coverage limits was a good thing, and Health Insurance companies could now no longer deny coverage on the basis of Pre-existing conditions. However, both of these changes increased the exposure of Insurance Companies, and those costs were passed on to the Customer – Mr. and Mrs. You-and-me. But the biggest insult about Obamacare was the ridiculous Supreme Court decision that effectively made purchasing healthcare mandatory; a mandate that has since been overturned by Executive Order, and rightly so, in my opinion.

The Healthcare system in the USA used to be a perfect example of capitalism in action; It takes about a million dollars and twelve years to train a doctor – about the same as a fighter pilot. Unlike the Air Force, however, the Physicians train themselves at their own expense, so it makes sense that they should set the value of their services. As an aside, this is tempered by the fact that the AMA and licensing authorities effectively conspire to restrict the supply of doctors, which keeps prices high. This seems to be working; there are, for example, plenty of unemployed attorneys, but the unemployment rate of qualified and licensed physicians is effectively zero, and an M.D. is often perceived, rightly or wrongly, as a license to print money.

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The problem with Obamacare is that it attempts to mix the worst of Capitalist and Socialized systems while getting the best of neither, and ends up being less than the less than the sum of its parts. The young were forced to pay for coverage that they did not want, in order to subsidize the unemployed, the itinerant, and the poor. The quasi-free-market Health Exchanges, while a good idea in theory, have not worked out well in practice; prices have spiraled in recent years, and many insurance providers have left the business or gone out of business.

I, for one, would like to see Obamacare repealed. But it will not be until something better is offered. And by “better”, I mean that “nobody loses any coverage that they currently have”, that simply won’t happen. This is in accordance with Prang’s Law of Freebies, which goes as follows:

“Once someone has gotten used to free stuff, they will never voluntarily give it up, and will fight tooth-and-nail to keep it“