And this is in Canada, where the author's surgery and other medical care was covered in full by universal health care. Without that, her situation likely would have been far worse, and yet we can still do so much better.
Going to go make a donation to North York Harvest now. Seems like I don't understand poverty enough to say that it's not needed.
This was a real eye opener to me too which sounds fucking stupid in hindsight.
This was different to my life in Australia. I was mugged and beaten a couple of times in Parramatta, NSW.
I feel like this discourages ppl from working on their own thing and makes labor market less flexible by forcing ppl into less that ideal positions.
But the USA does not provide healthcare for people who work and keep machine turning.
Hmm... I wonder if it's a political lobbying by healthcare industry to get more money for people who wouldn't provide it on their own by extracting it from the tax payers who do work and can (barely) afford insurance, etc.
EDIT:
People seem to think I'm being flippant or cruel but here's more background. I am not rich. I struggle to stay in the middle class. It doesn't take much to stop getting tax breaks but it takes a ton of money to survive. Paying $1,000 a month for health insurance on top of my already high taxes is a meaningful amount of money that greatly impacts where I can live, if I can retire and many other major life properties.
Sounds like a good situation to be in...
Not in a city -- because cities are established and built collectively, with infrastructure, and roads, and so on. Not allowed to use and own money, because that's a public good. Not allowed to have a citizenship (because a country is about people working together). No protection from thugs (because the police is a social good), and so on?
Does it sound enticing?
But, it's not a punishment. It's just a shitty set of laws -- fortunately, laws can change.
My point is this is not true for people who are on the upper end of middle class. You can't dodge anything because your income is taxed at income tax rates, not capital gains rates. You also get all benefits stripped from you as you rise in income. Can't get any breaks on health insurance, can no longer put money into a Roth IRA... Also remember, I'm not just talking about taxes. I'm talking about taxes plus the structure of the ACA.
The system is absolutely designed to put the middle class at the largest disadvantage. Whether you want to call it unfair or a punishment seems like personal preference.
All of the mandates for what qualified as a real plan were things that were being offered voluntarily by both of my parents health plans in the 90s. My mom is a retired teacher and my dad is a retired factory worker.
Getting nostalgic about the 90s isn't going to solve anyone's problem - not unless we're okay with euthanizing the elderly en masse to reduce the percentage of retirees back down to 1990s levels.
Also the plan offered through the exchange comes under a different pool with different cost. Insurance companies decide how to price group insurance for a company based on the demographics of a company.
Subsidizing health care for the poor would theoretically raise taxes not the amount you pay for your insurance.
Universal healthcare costing less per capita with a sane plan is not voodoo economics - we already pay more per person than every other industrial nation. There was nothing sane about keeping private insurance in the mix instead of just having a public option.
And seeing that retirees in the 90s and today come under Medicare, what does that have to do with private premiums?
2 million workers lost their employer provided health insurance following the ACA. Now they're paying for their insurance out of pocket. Granted their employers were paying their premiums, but from the person's perspective they went down from paying little or nothing to paying for all their insurance on their own.
> Subsidizing health care for the poor would theoretically raise taxes not the amount you pay for your insurance.
This is assuming that the subsidy covers the full cost of insurance. If this isn't the case then you're stuck paying an extra tax because your didn't buy the insurance that your can't afford.
> And seeing that retirees in the 90s and today come under Medicare, what does that have to do with private premiums?
Older people cost insurance companies more. 80% of healthcare costs are usually spent in a person's last year of life. Insurance companies can't factor age into cost beyond a government set limit. So the other insurance buyers subsidize the ageing insured population.
Fundamentally you're trying to say that the insurance companies can provide more services, charge high-risk people the same as everyone else, and greatly expand the covered population while reducing cost. That just doesn't happen. If a company provides more services and more expensive services then it's costs are going to rise. And because putting those costs onto the people that incur those costs mean than the majority of the insured population is subsidizing their healthcare and thus their premiums rise.
https://www.factcheck.org/2014/04/millions-lost-insurance/
This is assuming that the subsidy covers the full cost of insurance. If this isn't the case then you're stuck paying an extra tax because your didn't buy the insurance that your can't afford.
That was repealed last year....
Older people cost insurance companies more. 80% of healthcare costs are usually spent in a person's last year of life. Insurance companies can't factor age into cost beyond a government set limit. So the other insurance buyers subsidize the ageing insured population.
Older people wouldn’t be part of the private insurance pool. They would be part of Medicare.
Fundamentally you're trying to say that the insurance companies can provide more services, charge high-risk people the same as everyone else, and greatly expand the covered population while reducing cost. That just doesn't happen. If a company provides more services and more expensive services then it's costs are going to rise. And because putting those costs onto the people that incur those costs mean than the majority of the insured population is subsidizing their healthcare and thus their premiums rise.
And none of that is true. The insurance companies have a separate pool for what they offer for group insurance and what they offer on the exchange.
And older workers would be getting insurance through Medicare.
You’re conflating multiple risk pools. The insurance companies don’t do that.
Furthermore, I would suggest reading your sources in greater detail before posting them. The factcheck.org article does not deny the claim that millions lost their insurance through their employers. From the article:
> It’s true that insurance companies discontinued health plans that had covered millions of people who had bought them directly rather than through an employer. That’s because those plans didn’t meet the coverage standards of the new law.
> In a March 3 posting on the website of the journal Health Affairs, two researchers from the Urban Institute analyzed findings from a nationwide poll and said, “Our findings imply that roughly 2.6 million people would have reported that their plan would no longer be offered due to noncompliance with the ACA.” And in this case, the methodology is made explicit.
> That range could be higher or lower depending on what number is used for the total who had non-group coverage in the first place. The Urban Institute authors cite a study published last year that found estimates of the total number of people covered by non-group policies ranged from 9.55 million to 25.3 million. So if 18.6 percent of non-group policyholders got notices that their policies were being dropped because of the new law, as the poll indicates, then the actual number whose plans were dropped could be as low as about 1.8 million or as high as 4.7 million (coincidentally, the same as the AP’s figure), depending on how many had such policies in the first place.
Many "fact checker" sites try to "debunk" factually correct claims through whataboutism. This is prime example. It does not deny the claim that millions of Americans lost their insurance plans. It turns around and talks about how millions bought insurance on exchanges instead, as though this somehow refutes the previous fact. Using this to try and refute the claim that millions of people no longer have insurance through employment is intellectually dishonest.
> That [the tax mandate] was repealed last year....
Much to the disappointment of the ACA's proponents
> And none of that is true. The insurance companies have a separate pool for what they offer for group insurance and what they offer on the exchange.
> And older workers would be getting insurance through Medicare.
Not every retiree is over 65. And besides, Medicare is getting very expensive, too: https://en.wikipedia.org/wiki/File:Medicare_Parts_A_B_C_D.pn....
> You’re conflating multiple risk pools. The insurance companies don’t do that.
Exactly. Now that the affordable care act regulated insurance companies ability to determine patients, higher risk people are joining and having their healthcare subsidized by the other plan members. In the past, people either got their healthcare through insurance or subscribed to their plan when they were young and continued with it until old age. Now that companies are forced to charge the same rates, there's nothing stopping people from not buying any health insurance (or very cheap health insurance) until they start having high medical costs and then joining an insurance plan to have their costs born by the other customers. People are smart. If they can have their cake and eat it too by passing their costs off to other people, they're going to do it.
It's laughable to claim that providing more services, and increasing the quality of services can be done without increasing costs (short of some significant technological advancement). To claim that the same can be done while decreasing costs is beyond absurd.
How many retirees do you really think there are on individual coverage plans?
Besides that if you are part of a group insurance plan, they aren’t part of your group, or your risk pool.
Exactly. Now that the affordable care act regulated insurance companies ability to determine patients, higher risk people are joining and having their healthcare subsidized by the other plan members.
Do you really think that there are that many higher risk people who can afford to be on the exchange? And once again, they are not part of your pool if you are under a group plan. If they are part of your group plan, they would have been eligible for the same prices before the ACA.
Now that companies are forced to charge the same rates, there's nothing stopping people from not buying any health insurance (or very cheap health insurance) until they start having high medical costs and then joining an insurance plan to have their costs born by the other customers. People are smart. If they can have their cake and eat it too by passing their costs off to other people, they're going to do it.
If only the people who came up with the ACA had “mandated” health insurance or force them to pay a penalty. Oh wait! They did...
Not every retiree is over 65. And besides, Medicare is getting very expensive, too:
And that had nothing to do with the ACA.
It's that we help only the poor. Look, I pay taxes. Poor people don't. Fine. I get it. But they do get free medical insurance, I don't. They get free college, I don't. All I get back are reminders about "straight white men privilege". That's not fair.
Nobody likes paying taxes. But if it's "guys, let's all cough up what we can and build a greater society for all of us", I'm for it. If it's "let's build a greater society for the poor" - that's a much more bitter pill to swallow.
Poor people pay just as much as everyone else in sales tax, excise tax, tolls, meal tax, etc. And because they are poor, they pay disproportionately more of their income in taxes than the wealthy.
I live in the Boston area—even though there are 70 colleges and universities here, none of them are free for poor people.
That's incorrect. The tax rate is lower for lower income thus they pay less proportionally.
> I live in the Boston area—even though there are 70 colleges and universities here, none of them are free for poor people.
Every ivy league school has income adjustment and will offer free ride based on need:
https://college.harvard.edu/financial-aid/how-aid-works/harv...
If you look at what I listed—sales tax, excise tax, meal taxes—those are the same whether you’re rich or poor, except they have a disproportionate impact on the poor.
Poor people do get most of what they pay in income tax back once they file but that’s not the case for these other taxes.
A guy repairing my dryer has charged $350 for one hour. I'm sure some of it went towards spare parts and such, but even $50 bucks an hour is a pretty decent income.
I didn’t suggest that having a STEM degree was the only way out of poverty. My point: if poor students wanted to get STEM degrees, they often don’t have the high school preparation to do so and their families can’t afford the tutors, test prep courses and academic coaches affluent families have access to.
On top of that, if you are under group insurance through an employer, they have always been required to insure everyone at the same price except they could have a smoking surcharge. Your risk pool and the price you paid was determimed by the group you were a part of.
Unless you die suddenly, there is a good chance that at some point in your life, you will have a “pre-existing condition” that would have made you ineligible for health insurance.
But on another note: right before the ACA took affect, I was laid off from my job. That by itself was no big deal. I literally was laid off on Friday after the company was sold and started contracting for one of our customers the following Monday.
I went to get private insurance and no one would sell it to me because I had mild cerebral palsy. My CP is so mild that it only basically affects one hand, I was a part time fitness instructor, I had just run two half marathons in the previous year, and I hadn’t had any surgery besides foot surgery and that was 12 years prior.
I was getting paid more than enough as a contractor to pay higher premiums, I offered to do a fitness test - I knew I was in shape to pass any of the military fitness tests for my age - but they wouldn’t go for it.
As far as CORBA, yeah I ended up buying into the acquiring company's health plan. But guess what? They cancelled their health plan and there would have been nothing to buy into.
The ACA means that I could buy insurance.
My then fiancé/now wife said forget it. We moved our wedding date back six months, went to the courthouse, got married and I got on her insurance plan. She since chose another job with the school system partially to guarantee that after 10 years, we would have access to health insurance for the rest of our lives no matter what.
But why should someone have to go through these contortions to buy insurance at full price?
before the ACA, I was also unable to purchase health insurance from anyone at any price.
Why? Because, in 2004, I had my gallbladder out. Then I moved overseas for a year and a half, and didn't have an American-based health insurance plan. I came back, and boom, I have a "lapse in insurance" and a "pre-existing condition".
The ACA at least let me buy health insurance, although the plan is so expensive and so shitty I can't really use it for anything.
American health care is garbage, and we desperately need a radical change in how we care for people here.
Medicare for all already exists, it just requires that you quit your job (forever if you have a chronic medical issue) sell your house and assets and stop paying taxes, or having productive input into the economy entirely.
What kind of sense does that make?
Some homeless people get 'free' chemo, etc., but there are huge problems with the setup because with certain illnesses they're too well to qualify for hospice or housing or staying in the hospital full-time, but discharging to the street results in non-compliance with medication regimes because they don't have safe places or refrigerators to keep drugs, for instance. On the other end, hospice requires a lot of referrals and paperwork; if you can't get into the pipeline by getting all the referrals and evaluations and paperwork done, you don't get hospice, whether for money or for free.
It's worth noting that these gaps closed significantly with the passage of the ACA (ObamaCare).
Indeed, in many cases Medicaid requires you to become poor, by spending down personal assets first to pay for care, qualify for government support. (Arguably that’s the only fair way to do it. How is it fair for the government to use tax dollars to maintain the social status of a someone who was lucky enough to build up a nest egg, but unlucky enough to get cancer, where it won’t give money to someone who was unlucky enough to be born poor in the ghetto?)
I can state similar anecdotes of people I know having gone bankrupt due to medical debt or having died due to inability to afford care at the time (what with having no income for almost two years). "The government" did not step in to completely or even mostly cover life saving yet expensive long term care.
I've personally seen a (likely illegal) migrant worker helicoptered to Stanford hospital where they surgically re-attached a severed limb. Best standard of care available, far above what was required, with no possibility of repayment.
In states that didn't accept Medicaid expansion through the ACA, people who are poor are not eligible for coverage under Medicaid.
You can see which states accepted Medicaid expansion through the ACA here[2].
[1] FPL for a single individual is $12,140. For a family of 3, it is $20,780.
[2] https://www.kff.org/medicaid/issue-brief/status-of-state-med...
I'm unaware of a nation-wide program that covers parents under Medicaid at either 100% or 138% of the FPL.
The numbers I can find paint a different picture, for example, parents in Alabama are only eligible if they make below 13% of the FPL[1].
If you have another source, I'm genuinely interested in it.
[1] https://www.medicaid.gov/medicaid/program-information/medica...
For those unclear, the percentage is more than 100. Medicaid has long applied to people well above the federal poverty line, and in most places applies to people even further above it than before.
When you show up with an emergent condition, you get treated and kicked out. We probably spend more money on Medicaid for babies addicted to opioids than it would cost to privately insure mothers.
Edit: Yes, this was for BC or Alberta and is still the case in at least one of those.