GOP push to get more Americans into high-deductible health is dividing Democrats
GOP push to get more Americans into high-deductible health is dividing Democrats
Bipartisan legislation aims to get more Americans into high-deductible insurance, but perils would remain.
For thrifty consumers, there’s a lot to like in high-deductible health insurance. The plans offer low monthly premiums and those fees fully cover preventive care, including annual physicals, vaccinations, mammograms and colonoscopies, with no co-payments.
The downside is that plan participants must pay the insurers’ negotiated rate for sick visits, medicines, surgeries and other treatments up to a minimum deductible of $1,500 for individuals and $3,000 for families. Sometimes deductibles are much higher.
Let’s keep it civil.
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Wow, the number of comments that are just "oh, yeah, these are great, I have one" is... Wow...
No wonder you guys are fucked. Too many of y'all are spending your time supporting shit like this when you could be screaming about single payer, like the rest of the developed world has.
Are you equating ‘single payer’ with universal health care, which most of the world has, or true single payer in the sense that private insurance is effectively outlawed? The latter isn’t quite as ubiquitous, as you know, and is politically a heavier lift in the U.S. compared to the starting point of simply guaranteeing universal basic coverage through something like medicare (state insurance) expansion.
The latter approach, incidentally, has majority support here, if polls are to be believed. I share your astonishment that we have somehow been unable to successfully agitate for it. We could realistically get to where Germany or France are, but somehow … can’t.
The US has basically all 4 major healthcare insurance systems in a single country.
The Beveridge model, used in the UK for its National Health Service, is essentially socialized medicine where the government literally owns the hospitals/clinics and employs the doctors and other professionals who work within that system. It exists in the U.S., too, in the Veterans Health Administration system, and the military's own hospitals, plus a few smaller systems like the Indian Health Service.
The Bismarck model, common in much of continental Europe, is essentially an "all payer" system where private insurance can still exist, but where all the insurers are paying the providers the same prices for services. Providers are private, but the highly regulated price structure means that private providers can't just demand their own prices (lest they get cut out of the insurance system entirely). Insurers can be private, too, but all plans must offer specific features, in a way that ends up pushing the pricing and coverage to be fairly uniform throughout the system. This exists in the U.S. in the employer-provided health insurance system, or the "Obamacare" ACA exchanges, where most states regulate what insurance coverage there can be, what prices they can charge, and then all the providers and insurers negotiate prices that end up looking pretty similar. Realistically, someone who gets Aetna through their employer doesn't have all that different of an experience from Blue Cross Blue Shield or Cigna or United.
The Medicare model, or single payer model, basically puts everyone on one public insurance plan and has that insurance system negotiate prices with providers as a monopsony. Doctors and other providers don't have much room to just opt out of the system, because in a society where everyone has insurance for no or low out of pocket expenses, doctors won't be able to charge significant out of pocket expenses for normal services. It's what Canada has, and what the United States has for everyone over the age of 65, as well as everyone under the age of 18, and most people below the poverty line.
The chaotic market-driven model, where patients and providers essentially shop around and negotiate one-off pricing for services, is basically what remains for anyone not covered by the three models above. It might be how markets work for most other stuff in the western world, but among developed nations only the U.S. uses it in a significant way for health care markets.
Single payer, or Medicare for All, is at least something that one can envision for the United States, but I think it's far more likely we end up with something like the German/Swiss model, which probably would be the easiest transition among the 3 major universal health care models. One disadvantage is that it doesn't really look like what we see in other English-speaking countries (Canada's single payer, UK's socialized medicine), so there aren't as many people explicitly calling on the U.S. to adopt models already implemented in other countries.
Great perspective. Thanks.
I mean. yeah single payer is nice, however that's really not even on the horizon for the US. For most Americans, especially those who actually have to know how to fully utilize their insurance (if lucky enough to have it), there's no benefit for them to worry too much about a single-payer or socialized system. They have immediate needs and immediate solutions. They need to get their prescriptions, their surgeries, and their doctor's appointments. It's not "supporting" it, as so much as it is the devil you know.
Practically speaking, compared to standard PPO/HMO insurance, HDHPs are pretty good. If you are low-maintenance health-wise, you don't pay for your physical, are going to spend maybe couple hundred bucks on sick care and maintenance meds. If you have chronic illness, you will only pay the deductible before your care is 100 percent covered, so a hospital stay would be enough to meet your out-of-pocket max, and everything else is covered 100% by your insurer (whereas the traditional plans have 6-10k limits, the HDHPs are much lower at 1-2k for a person and 2-3 for a family). Especially with HSAs, which are savings/retirement accounts for medical expenses, that some employers will pay into, so basically free money to pay copays, prescriptions, even stuff like aspirin and bandages.