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<p>How do you know that? In order to quantify efficiencies, you have to compare apples to apples. As an example of some reasons, see the article below.</p>
<p>[The</a> Myth of Medicare’s ‘Low Administrative Costs’ - Forbes](<a href=“http://www.forbes.com/sites/aroy/2011/06/30/the-myth-of-medicares-low-administrative-costs/]The”>The Myth of Medicare's 'Low Administrative Costs')</p>
<p>Geo, there is a pretty substantial body of work out there that takes a fair amount of care in trying to equalize or control variables in the cost of healthcare delivery globally, and its pretty clear that others have found ways to spend less, waste less, and get more. Several studies in the New England Jounal of Medicine and NIH dissect this endlessly. For a dated but reasonable roundup of some of this info, there’s actually a wiki link that cites many of these studies as a part of a larger comparison.
[Comparison</a> of the health care systems in Canada and the United States - Wikipedia, the free encyclopedia](<a href=“http://en.wikipedia.org/wiki/Comparison_of_the_health_care_systems_in_Canada_and_the_United_States]Comparison”>Comparison of the healthcare systems in Canada and the United States - Wikipedia)</p>
<p>While the Forbes article points out some considerations superficially as related to medicare, it does not address gross percentages of GDP…so if the US spends 17% of GDP compared to Canada’s 10% of GDP and 31% of the US spend is admin, for example, the percentage is already accounting for the higher spend averaged over all age groups.</p>
<p>My husband works for a small company based in another state. We will not be able to keep our current insurance due to the upcoming changes expected because of Obamacare. We will be paying significantly more AND will be forced into a network of providers which includes hospitals that we would NEVER willingly go to for any procedures, so if either one of us requires any sort of elective surgery (and I have had significant issues with my back and knees in the past), we’d need to go “out of network” and pay significantly more.</p>
<p>Churchmusicmom, why won’t you be able to keep your insurance? Are they switching to a plan which won’t cover any providers where you live?</p>
<p>A personal anecdote about why care is costly. </p>
<p>I recently went for a screening appointment prior to a colonoscopy.</p>
<p>I first saw saw the receptionist. Next a woman appears who takes my vital signs. I ask her if she’s the APRN who was the point of my appointment, but she’s a medical assistant. Next, another woman takes me to a room where the APRN eventually appears. After a chat and a brief checkup, she takes me to yet another woman who schedules the colonoscopy procedure. </p>
<p>So five people for one visit–and I won’t even see the doc until the actual procedure. I don’t see why I couldn’t have seen only one person–the APRN. There is no reason why she couldn’t have found me in the waiting room, did both the vital signs and the checkup, and then scheduled the procedure. </p>
<p>Maybe there’s some economy of scale or division of labor that I’m missing, but I’m not even sure about the need for the screening appointment. My primary care doctor has my recent vitals, etc. on file. </p>
<p>There are doctors and other provider offices, many shrinks, for example, that don’t even have a receptionist. You sit in the waiting room and they open the door to the consultation room and say, hi. </p>
<p>Many of these people outsource their receivables, which significantly reduces overhead. That’s an economy of scale and reasonable division of labor.</p>
<p>Perhaps one outcome of the ACA–and the move to electronic medical records may help–will be a more efficient organization of the delivery of care.</p>
<p>^^^My sister relays a story of her daughter falling of a bike and obviously in need of stitches during an off continent vacation. They were routed to a small town Dr. who came into her office on a weekend just to see my niece. Dr. looked at knee, said it needed stitches, put in stitches and gave a few antibiotic pills which were kept on hand in the office. My sister was told to ‘keep an eye on it’ and if it gets red to see another Dr. If not, just have stitches removed when they got back to US, or if they are comfortable they can take them out themselves. Oh, and no paper work, just $40 cash.</p>
<p>In a US this would require a 24/7 fully staffed urgent care facility. A receptionist for check in, a pre-examination examination for BP, family history (yes, one must know if niece’s grandparents ever had heart disease or cancer before stitching a knee), a taking of temperature and a look into the ears, a listening to the heart and lungs and maybe a check of reflexes. It would require a physician who checks the wound and most likely a NPR who then ‘stitches’ it. The ‘stitching’ is often just a medical version of crazy glue. And probably a 2-3 hour wait.</p>
<p>Another personal ‘off continent experience’…while bathing my two kids, then ages 2 and 5, I turned around for a moment and within a few seconds heard blood curdling screaming. It was obvious my son was bleeding from the mouth. Wrapped him in a towel and took him to local hospital. Ran into Urgent Care/ER. A physician came out, looked in his mouth, said he bit his tongue and that type of wound bleeds a lot, told me to take him home and have him drink cold liquids if it looks like he’s in pain. THAT’S it!!! No intake paperwork, no family cancer history, and…when I asked where to pay…he just said…it’s too much paperwork, let’s just forget it…have a nice evening…maybe drink a glass of wine when you get back home!</p>
<p>I do remember my US pediatrician having a very similar practice and approach…her office was a bedroom in her house she shared with DH and mom. </p>
<p>Oh but for the good old days…</p>
<p>Moderator’s note:</p>
<p>Single payer is not the law and at this time it is considered a political discussion. Any posts referring to single payer will be removed.</p>
<p>churchmusicmom,</p>
<p>I too am curious about why you won’t be able to keep your current insurance, and in what way the insurance change will be because of Obamacare, but I also wonder how you already know the facts about your new insurance.</p>
<p>I recommend the Kaiser Family Foundation research:</p>
<p>[Health</a> Reform | The Henry J. Kaiser Family Foundation](<a href=“http://kff.org/health-reform/]Health”>Health Reform | KFF)</p>
<p>for lots and lots and lots of information about health care costs in the US and possible consequences of the ACA. </p>
<p>The Kaiser Family Foundation is also a good source for information about the current US health care system. Before I took an online course on the ACA and read some of their work, I had no idea that, for instance, 40% of the births in the US are paid for by Medicaid, or that almost half of Medicaid expenditures go to long term care (eg nursing homes and home care for seniors and the disabled).</p>
<p>The plan we currently have with DH’s small company (based, as I said in another state) has become prohibitively expensive for the other families (who live in that state—most of them have small children. DH and I do not). Rate increase was to be crazy high. The option that the group of employees chose to go with is still more expensive than previously, but not as high as what we all had. The employees were told by the professional insurance broker person (or whatever her title is) that this extraordinary increase is due to changing regulations related to the new law. And this is just for the next year. The NEXT year is still an unknown, but not looking any better.</p>
<p>What Obamacare regulations did the insurance broker say were causing the extraordinary increase in your premium costs?</p>
<p>Did the previous insurance have yearly caps or lifetime caps? Obamacare outlaws them. Requiring your husband’s company to provide health insurance that actually insures you if you get really sick, instead of insurance that goes away if you get really sick, could drive premiums up.</p>
<p>Fang…the ACA will have a negative impact on a whole lot of people…you might not believe it, bit it’s true. No need to try to minimize when someone posts true life ramifications of the ACA and how it will negatively effect them…folks…many, many people will not be able to keep what they had, or have pay a heck of a lot more. I have already posted the rate structure changes that the ACA has posed on BC/BS in my state.</p>
<p>In addition to looking at the yearly caps on the previous vs. current plan that Cardinal Fang mentions, you should also look at the annual maximum that the insured could pay. There’s a point in between the deductible and the annual maximum where an insured is paying a certain percentage – typically between 20-30% – and that can run up very quickly in a high cost situation. Under ACA that maximum is roughly $6500 – but it could very well be that a non-compliant plan sets it much higher. </p>
<p>One exercise I do for comparison is simply to create a spreadsheet to see how the numbers come out for my expenses under various scenarios: What’s the base cost if I have only routine annual expenses (lets say, $750 total)? What if I have $5000 of medical costs? What if it is $10,000? $20,000? $30,000?</p>
<p>(That’s how I figured out that I’m happy with my current HSA unless rates go up unexpectedly, but that if I went to an exchange that I’d choose the bronze plan over silver – I probably won’t qualify for a subsidy, I can easily afford my deductible, but it’s on the high end where I would get in trouble. My current HSA has a $5000 annual maximum out-of-pocket.)</p>
<p>I’ve actually been through this exercise a lot because I’ve always had to buy insurance on the private market, and I’ve had to help my son with private-market insurance choices as well. It’s easy to look at the front end costs of monthly premium and deductible – but it is those back end costs that are the ones that end up bankrupting families. </p>
<p>It really doesn’t take all that much to run up a 5 or 6 figure hospital bill. </p>
<p>60% of US Bankruptcies are due to medical bills, and 78% of those bankruptcies are people who have insurance coverage. [60%</a> of US Bankruptcies Due To Medical Bills, While 78% Of Those Bankruptcies HAVE Insurance Coverage | Economy](<a href=“http://beforeitsnews.com/economy/2013/03/60-of-us-bankruptcies-due-to-medical-bills-while-78-of-those-bankruptcies-have-insurance-coverage-2500492.html]60%”>60% of US Bankruptcies Due To Medical Bills, While 78% Of Those Bankruptcies HAVE Insurance Coverage | Economy | Before It's News)</p>
<p>geeps, while I think you are absolutely right, there are many (I’m not referring to CF in particular here), that think that the negative ramifications this will have on many people are irrelevant. They don’t mind one bit that some people may lose what they had and that many will be forced to pay more for less. It’s the philosophy that overall it will be better for the country, so if some people have to pay more/lose more, that’s just what has to happen. I still don’t see why we couldn’t have fixed the things that were broken without the gov having their hands in everyone’s business, but that’s just me.</p>
<p>I’m hoping that when it all shakes out, they will fix the problems eventually. Unfortunately, that may be way after you pay tons of additional cash.</p>
<p>Churchmusicmom, I’m sorry your H’s company are not able to keep their previous plan but companies have frequently changed plans and the terms of those plans, ie - % the company pays, % the employee pays, added co-pays, raised deductibles, etc. I worked for my father’s company in employee benefits in the 80’s (a fast food chain with approx 1000 eligible employees) and we had to switch plans seemingly every other year to keep costs down as much as possible. Even with that size group just a few preemie births would effect the premiums. </p>
<p>This is nothing new.</p>
<p>We have not established yet whether churchmusicmom is paying more for less. Perhaps she will be paying more for more: elimination of caps, coverage of preventative care, or something. But I would like to understand exactly which provisions of Obamacare, if any, are causing the rise in churchmusicmom’s premium for the insurance she liked. Some unscrupulous brokers and insurance companies are claiming that Obamacare is the cause of premium increases, when they are unable to point to any actual provision of Obamacare that would cause the premium increases.</p>
<p>The yearly caps and lifetime caps in insurance are insidious: if you don’t hit them and you aren’t paying attention, you are happy with your lower premium, but if you do hit them, you are wiped out. But then, it’s always the case that “insurance” that fails to actually insure against catastrophe will be cheaper than insurance that does insure against catastrophe.</p>
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<p>Many news articles today bringing to light that the out of pocket (OOP) maxes will NOT apply in 2014. (don’t want to venture into the political area so google -ACA out of pocket max delay) It is yet another ‘deferred’ part of the plan. So, in 2014 you many not see the entire increase resulting from the ACA. The full costs will make themselves known in 2015. Consider what is happening to the ACA backers between 2014-2015…it’s easy to see why the real costs need to remain hidden for another ‘season’.</p>
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<p>OOP maxes will apply for some plans, but not for others, for 2014.</p>
<p>Geeps, the point is that the positive outweighs the negative. Any law or policy that helps some people will inevitably hurt others – that’s why big companies pay big bucks to lobbyists in D.C. to look out for their interests. </p>
<p>In the case of insurance – there is a class of people who have enjoyed low premiums because they are easy to insure (no disqualifying pre-existing conditions) and have historically qualified for preferred rates. I happen to be in that class myself.</p>
<p>But we aren’t the problem that ACA was passed to solve. Our preferred rates came at the expense of a market that shut the doors on anyone who was likely to cost the insurers money, and thus protected our pool from high-cost customers. It’s like the insurance equivalent of living in a gated community – yes, our rates were lower, but that’s a direct result of exclusionary policies directed toward others.</p>
<p>The problem is that there is a huge segment of the population who have higher medical costs and who historically have not been able to qualify for any sort of insurance that they could afford. They couldn’t depend on employer-provided insurance because their health problems made maintaining full time employment precarious; they couldn’t buy into the independent market because they were either shut out entirely, or offered policies that specifically excluded the medical conditions that were costing them money, or offered policies at astronomical rates. Some had been insured but were dropped from policies after their medical expenses increased, or had expenses far in excess of the annual or lifetime limits of their policies. </p>
<p>The question is: how do we get those people covered? There are three choices: (1) do nothing, and let the problem continue, knowing that the problem can only get worse over time as more and more people fall into that category of uninsurable; (2) create a new government plan to cover those people, at taxpayer expense (such as expanded Medicaid or Medicare eligibility); or (3) continue the system of private insurance, but make it possible for private insurers to provide coverage to the high-risk group by expanding the insurance pool and putting the high-risk group in the same pool with the healthy. </p>
<p>ACA goes for option 3. After 2014, if I go shopping for new policy, I’ll have to buy from the same pool as all of those sick people. My costs will go up - but that’s because I have been paying an artificially reduced rate for years. “Artificially reduced” because the only way that my insurance company could afford to give me those rates was by creating a pool that excluded all the sick people. </p>
<p>The reason I support this move is that I don’t have to look very far to find the excluded sick people. They are my near relatives and close friends. And I also know that it’s inevitable that I will join the ranks of the “sick”, although I have always hoped that time could be deferred until after my 65th birthday – only because of the existence of Medicare. But I also worry about my kids, my grandson, and my other future grandchildren. </p>
<p>So yes, Geeps, we know that there are some people who will be paying higher rates. No one is arguing that point. The point is that there is a balancing of needs— the higher premium that I pay because of ACA is trivial compared to any one of those people referenced in my link above who were bankrupted by their health costs, even though they did have insurance.</p>