winstonYou can always count on Americans to do the right thing – after they’ve tried everything else. Winston Churchill

Beginning October 1, Americans can begin enrolling in the insurance exchanges established in ObamaCare (more information here, here and here). For those folks living just above the federal poverty line (about $31,000 for a family of four this year) you can get a subsidized insurance policy for your family which takes effect on January 1 for as little as $600 a year. Unfortunately, if you make $70,000  and are ineligible for insurance through your work, the coverage will cost you about $4,500. The calculator for your situation is found here.

Wow, you say, that is a lot! Why does it have to be so expensive?

I wrote briefly before (found here) about Paul Starr’s new book detailing the problems with our healthcare system  (the “policy trap”). Here is a little more detail:

  • Many of the costs have been hidden for a long time. Not a problem before but now we are now in a global economy and spending a lot of money on health care  We spend roughly $8,000 per capita on healthcare which is much higher as a percent of GDP than any of our competitor nations. If we were healthier this would be defensible but by any objective measure we get so-so care for our dollar. Multinational corporations look at the percentage spent on healthcare as well as the projected amount and elect not to create jobs here
  • There has been confusion about the role of health care (is it a right or a commodity? Do people who contributed to their disease deserve the same care as the innocents?) Despite all the money spent, the number of people who lack access to all but either heroic or charity care is staggering. This creates a problem when people delay needed care. no only does this clog up emergency rooms but also results in lost productivity and needless suffering and death.
  • We believe we get good care mostly because half of us never access it. The quality of our care, by any objective measure, is not as good as it should be. We don’t follow evidence as we should (video explanation here). We offer bead advice often and occasionally so bad it results in patient death. We err on the side of overtreatment for various reasons and that overtreatment results in harm more than we’d like to believe.
  • There is no grown-up in charge so deciding how to spend money is hard. My friend Josh Freeman has a great post (found here) about why the market doesn’t work in almost all of healthcare. As he points out, the one certainty is that we are all going to spend a lot of healthcare dollars at some point in time in an attempt to defeat death yet none of us has accomplished it yet. Someone needs to say, enough.

So now what? The Affordable Care Act includes areas that address all of these. The coming of the exchanges creates cost transparency which will at least let people know what they are paying for. The mandate gives everyone skin in the game. Payment changes to encourage quality (and this aspect could be strengthened even more). Though there is still no central control, the is a lot more centralized decision making possible through several of the mechanisms found in the law which should lead to cost reductions (and many say have done so already).

Again, not perfect but potentially transformative. Perhaps, as Winston Churchill said, we are doing the right thing.   Here is a cool video on how the whole system works that I would encourage you to watch.  Let’s make this the right thing.