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Ala Carte Health Care

Prior to Obamacare we had health insurance with a deductible of $10,000 per person per year. The only thing it provided to us was a vague reassurance that if something catastrophic happened, we would have help for all the expenses between $10,000 and 2 million dollars. Mental health was not covered. Maternity was not covered. Birth control was not covered. Dental and vision, not covered. Also my premiums went up every year like clockwork.

We made the switch to Obamacare the second year it was offered. I watched that first year to see if it actually worked for people I knew, and it did. On Obamacare my premiums were about the same as they had been on my old plan, but my deductible per person came down to $3000, and there was a $7000 cap per family. Suddenly a catastrophe which affected my entire family would put me out $7000 instead of $60,000. And there was no upper limit on how much the insurance would spend. Mental health, maternity, birth control, annual check ups, and vision check ups for my kids were all covered. True I still had to pay out of pocket for these things, but all those payments counted toward a my deductible rather than being unrelated to it.

I would have loved to have all those things covered in my earlier plan, but adding things like Maternity care were called riders. They cost more money. Not only that, but you couldn’t add a maternity rider to your plan if you were already pregnant. You had to add it several months before you got pregnant in order for the insurance company to agree to pay for anything. Mental health care wasn’t offered at all, not even as an expensive rider. I suppose that there were people whose coverage was provided by their employers who had coverage for mental health stuff, but I didn’t know any.

That is what the newly-proposed ala carte model for health care means. It means that those who have health needs, like maternity care, will have to pay more than those who don’t have needs. Guess which person will have less ability to work to cover the cost of their health care? Ala carte means that some things won’t be covered at all, or will only be covered at rates which are so high no one who has the issue can afford to purchase coverage for it. I suspect I’d be back to out of pocket for my family’s mental health care.

It is true that year after year I saw increases in my premiums for Obamacare. This past year my monthly premium went up by $600, an increase of almost 60%. That was alarming and has put a serious strain on my budget. I had to drop down to a plan with a $7000 deductible per person and a $13,000 deductible for my entire family. Yet those deductibles are still lower than the ones I had before Obamacare. And visits to mental health professionals count toward those deductibles. Also, I believe that my premiums would have skyrocketed anyway. There are other things driving the increase in medical costs than just giving coverage to more people.

There were definitely things to fix, but prioritizing the profits of insurance companies is not how to help people. Ala carte may help a few healthy people lower their premiums, but it will cost everyone else more.

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3 comments to Ala Carte Health Care

  • Sean M

    Are you telling me that someone in the USA can consider themselves to have health insurance if they have to pay the first =several thousand dollars= per year? And that a family of 6 pays $1600/month for that? That sounds crazy! Living in Canada and Austria, the cost of insurance has usually been on the order of 50 to 100 dollars or Euros per month, with a few hundred dollars or Euros per year of miscellaneous expenses.

  • Roger W

    Seriously. Move here to NZ if you can.
    that’s so000oo far past insane.

    Over and above the “free” healthcare, I pay ~$1600 per YEAR for the ability to got for private elective surgery, or bypass waiting lists (e.g. ingrown toenails, or gall bladder removal), with a $400 “excess”

    Flip side: Earthquakes. And because of that the mental health side of the public system is very overloaded.

    BTW, did you know the premiums thing has a name?
    Cost Disease
    https://slatestarcodex.com/2017/02/09/considerations-on-cost-disease/

    We have a company here “YouI” that targets “good risk” clients.
    Got hugely dumped on when it was revealed that (as an example) someone wanted to insure a $5,000 motorbike and got quoted around $7,000 per year because they’d had 1 accident.

    • Earthquakes wouldn’t bother me much. I grew up in California. Though yours may be more frequent / worse.

      I’m not sure whether our business could be easily ported. There are literal tons of inventory and if all of our customers except New Zealanders had to pay international shipping rates, sales would plummet.

      But I’ll admit to considering re-locating, at least in passing.