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Comment by danjoc | Hacker News Reader

Affordable Care Act?

https://ycharts.com/indicators/us_health_care_inflation_rate

Health care is not becoming more affordable. The rate of inflation in health care is significantly higher than the US inflation rate.

https://fred.stlouisfed.org/series/T5YIFR

How is that affordable? How are $600 epi-pens affordable?[1] How is a 4000% price hike on a 62 year old generic affordable?[2] Google for "snake bite hospital bill." $153,000. That's not affordable. That sounds downright fraudulent.

It seems they should have named it something more appropriate, like the Universal Health Insurance Act. Insurance that is no more affordable than the overpriced health care available in the country. But point this out, and everyone starts their partisan bickering and nothing gets done at all.

[1]https://www.bloomberg.com/news/articles/2016-08-29/mylan-to-...

[2] https://www.washingtonpost.com/news/to-your-health/wp/2015/0...

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Those price increases are not from the ACA, they're the result of Medicare Part D, which took effect in 2006.

From the wiki[1]:

By the design of the program, the federal government is not permitted to negotiate prices of drugs with the drug companies, as federal agencies do in other programs

The bill forces the government to pay whatever the pharma manufacturers will charge. If you were selling a product and there were a law preventing your largest customer from negotiating the prices which you set, why wouldn't you heavily inflate your prices?

[1]https://en.wikipedia.org/wiki/Medicare_Part_D

>Those price increases are not from the ACA, they're the result of Medicare Part D, which took effect in 2006.

Oh good, let's see you present to me evidence that the inflation rate of health care in the US is below that of the inflation rate of the country as a whole. Can you do that? Because that's my point.

Health care is not affordable. Hospitals are charging tens of thousands of dollars for treatments that cost a couple hundred dollars 2 hours away across the border.

http://archive.azcentral.com/business/articles/20120831scorp...

That's fraudulent. Put those people in jail.

Oh good, let's see you present to me evidence that the inflation rate of health care in the US is below that of the inflation rate of the country as a whole. Can you do that? Because that's my point.

No, because the cost increases were not due to the affordable care act, they were due to Medicare Part D. The goal of the ACA was to reduce the number of people without insurance. Controlling pharmaceutical costs is outside of the scope and for that you can blame the law that specifically forbids the government from controlling pharmaceutical costs.

>No, because the cost increases were not due to the affordable care act

You're distracting from the real issue with a different argument. I didn't say the ACA caused the increases. I am saying the Affordable Care Act failed to make health care more affordable.

Wrt to your first link[1], the very first sentence in the overview tab states, "US Health Care Inflation Rate is at 3.98%, compared to 4.26% last month and 2.95% last year. This is lower than the long term average of 5.40%."

I don't intend any snarkiness, but am I somehow misreading those numbers? I'm reading that statement as "an inflation rate of 2.95% for the last year compared to the long term average of 5.40% could be equated with 'more affordable'".

[1] https://ycharts.com/indicators/us_health_care_inflation_rate

It's an improvement over the status quo but it still has health care costs increasing faster than the rate of inflation. Which is pretty easy to characterize as health care getting less affordable, even though it is likely an improvement.

The long term inflation rate of the US is much lower than that as a whole. That's the point. Inflation in health care exceeds inflation in the US as a whole.

That is the core issue. That was not solved by the ACA. How do we solve it? Ideas? Oh yeah, you know what? Let's argue about Obama and Trump instead. That will surely work. Look at the comments in this thread.

If I asked you how to solve a sorting problem, I'd have a dozen good solutions presented. If I ask how to solve a healthcare cost problem that many other countries don't seem to have, everyone's brain switches off and they go into arguing about politics.

"Health care inflation" isn't directly comparable to the overall inflation rate, as the quality and amount of health care has been rising alongside the increasing percentage of GDP we spend on it. Compared to when the only available remedies were bloodletting and leeches, I bet we spend a lot more on the health care sector.

Are you seriously making excuses for the overpriced health care in the US? Every other country has the same procedures we have in the US at lower prices.

http://ritholtz.com/2012/03/comparing-medical-procedure-cost...

You're blaming an act meant to increase access to healthcare (which it does) for the prices that drug companies choose to charge?

If you look at that chart for a longer period you'll see the rate under the ACA was less than most other periods

http://imgur.com/a/ShbpW

The ACA wasn't a bad attempt given the constant efforts of the opposition to sabbotage it.

> The ACA wasn't a bad attempt given the constant efforts of the opposition to sabbotage it.

Actually, it was, given that many of the misfeatures of the ACA were premptive compromises to gain the support of opposition that never accepted it anyway.

But even so, it's better than the status quo ante was, and there's no sign of anything better on the horizon amidst the rush to repeal it.

I don't think we need any partisan bickering to address your point:

It seems they should have named it something more appropriate, like the Universal Health Insurance Act.

The name of the bill is a lot less important to most people than the substance. If you read Sam's post, there is a man in there with a heart condition who is essentially uninsurable without the ACA. For him, the word "Affordable" definitely applies, but he doesn't care what the bill's title is. In my opinion, you shouldn't either, because the bill's substance is what is important.

Substance? Health care costs continue growing significantly faster than inflation since the passage of the Affordable Care Act.

>In my opinion, you shouldn't either

It's clear to me, I need to leave and go to a country with a higher average IQ. They, unsurprisingly, have figured out how to deliver actual affordable care. The people here are too ignorant to actually solve this problem. Even "smart" people have been completely brainwashed by propaganda.

Affordable care is more expensive. War is Peace. Ignorance is Strength.

ACA raised the bar on the minimum level of coverage for private plans. This means that the shitty door-to-door private plans you make movies like The Rainmaker about had to increase costs to start providing actual coverage for healthcare.

You can tell because while some premiums have increased, the overall healthcare costs (including premiums) for all Americans has been reduced.

If you'd said "most" I wouldn't have responded, but since you said, 'all': My out of pocket expenses are drastically up; the smallest deductible I can get now is $3,000 (after that, it's covered at 80%). I'd have to see the doctor > 120 times a year for my overall healthcare costs to be anywhere close to what they used to be, and that's exclusive of premiums (~6x what they used to be) and drugs (haven't checked lately, but last time I looked, they were around that same multiple).

I think you've confused your out of pocket with deductible, and misunderstood what type of plan you should be on.

You should only focus on a low-deductible plan if you know you're going to be in and out of the hospital (e.g. elderly, chronic, etc.). I also don't think you know what your out of pocket maximum is now compared to what it was before.

I have a deductible of $3,000. If I spent it all on doctor's visits (that is the vast majority of my medical expenses), I'd have to visit the doctor 120+ times to make it cheaper to have a $3,000 deductible than a $25 copay for doctor's visits. My out of pocket is quite a bit higher than that $3,000 deductible.

You're correct that I don't know the difference in out of pocket maximums, but I do know it's a great deal higher than it used to be.

As for "what type of plan I should be on", I really don't have a choice. My employer offers what amounts to basically the same plan through two different insurers, and the main difference seems to be which doctors are on which insurer's network, so in practice, it doesn't matter which one I pick-- the out of pockets maximums are broadly similar, and the deductibles are identical.

Another point to consider: my out of pocket maximum might be lower (it's not, but let's assume it is), but so much less is covered now than before. I used to have a copay for doctor's visits, ranging from $20 to $30 depending on my employer at the time. So if I was visiting the doctor say, a dozen times per year (including wife and kids), I was paying $100/mo + $30/visit = $1,580/yr just accounting for doctor's office visits. At $300/mo and $140/visit (average; higher if tests are performed), that's $5,280 in out of pocket costs for doctor's office visits.

And that's not counting specialists-- my daughter had a heart defect at birth, so now she has to see a cardiologist every other year, which has the happy(?) benefit of pretty much eating up my entire deductible in one fell swoop right there; before the ACA, I paid $50 for a specialist visit and maybe a few hundred extra depending on which tests that particular specialist ordered.

Exactly. Along the way we accepted the premise without even realizing it -- "everyone should be able to afford health insurance [implicit: no matter what it costs]". Sounds great, but only really serves to put money in the pockets of rich hospitals, nurses' unions, big pharma, etc.

Making healthcare actually affordable -- as in, reining in costs -- is where we should be looking.

Pull in the reigns on big pharma, they're primarily responsible for the outstanding inflation of medical costs.

Other ways to lower healthcare costs:

* Increase med-school acceptance rates & fund more residency programs/additional slots to increase supply of MD's

* Subsidize med-school tuition so MD's don't graduate drowning in debt

* Allow PA's and NP's more authority in primary care and non-trauma emergent care situations without an attending physician having to sign for every order and discharge - some states are ahead of others here, we have a lot of NP's in GA ER's that work without an attending

Oh, and single payer healthcare would do wonders too. Administrative costs for hospitals and billing companies would drop dramatically not having to manage dozens of different insurance contracts just to get paid, would love to pass that savings onto patients.

> Health care is not becoming more affordable. The rate of inflation in health care is significantly higher than the US inflation rate.

I think healthcare has become a jobs project. As manufacturing employment decreased, many found replacement jobs in an ever-expanding health care industry.

There is no incentive for anyone to get medical costs under control. The health care delivery system has every incentive to use the "blank checks" offered by the insurance industry. The insurance industry makes a certain percentage off whatever they pay out in claims, so their incentive is to pay as much as possible.

Patients want to feel better, and aren't in a position to evaluate whether the recommended treatments are actually their best option.

> But point this out, and everyone starts their partisan bickering and nothing gets done at all.

In the early days of medicare the government's costs quickly got out of control. The first reform was to figure out what a procedure should actually cost. It's been "trench warfare" between doctors and payers ever since.

I have some anecdotes from my passengers and friends that would hopefully sidestep the bickering to point out that the status quo is quite harmful to the health industry's customers...

Iatrogenic conditions are exceedingly common. These are conditions caused (or worsened) by the treatment provided.

For example, hospitalists (doctors who manage patients' care in a hospital) are starting to look at old patients' pile of prescriptions to figure out which ones are actually necessary [1].

[1] When less is more: De-prescribing medications - http://www.acphospitalist.org/archives/2016/05/deprescribing...

So your primary complaint is with the price of pharmaceuticals, and perhaps the cost of health care in general in the USA, and not health insurance itself.

If only there was some large body that was able to negotiate reasonable rates for health care on behalf of consumers... it's amazing nobody in the world has figured this out before!

The ACA pretty clearly made health care more affordable than it would have otherwise been[0]. Still, it was an incremental change and a huge compromise compared to what I'd really like. It doesn't make sense to mock the name of the Affordable Care Act when it is in fact helping with affordability. We should do a lot more, but your criticism seems misdirected.

[0]: Here's one source, although there may be better ones http://www.latimes.com/business/hiltzik/la-fi-hiltzik-obamac...

Less Unaffordable for 20% of the Population Heath Care Act ?

Mandatory Purchase of Service from Private Industry Act ?

either way it was a redistribution to some at the expense of others. decide yourself which moral side you sit on.

Do you feel the same way about the liability collision insurance your state government requires you to buy to drive on their roads?

how can you tell how I feel from that comment? the law doesnt print money, it comes from somewhere.

the two sides were 1) it being redistribution to people who cant afford insurace, or 2) it being redistribution to insurance stock holders

I didnt even pick a stance, and youre assuming my position. or they arent mutually exclusive choices.

here's a better version of the first chart: https://data.bls.gov/timeseries/CUUR0000SAM?output_view=pct_... This is medical cost inflation for all urban consumers.

If you put the starting date at 1970/1980/1990.. it really puts things in perspective.

Take a look at the longer chart.

https://data.bls.gov/pdq/SurveyOutputServlet

It's up to a historic rate of growth that has been typical since the early 90s.

The average might have gone up, but the it's the high-end that's supposed to have come down. Health care costs are the #1 cause of bankruptcy in the country.

Wasn't there more fixes in the initial version of the legislation that would have dealt with this?

I'm sick of these stupid names in general.

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