Post-ACA you can now purchase coverage from any of a variety of companies through the exchanges. Rates are limited in that there's now a legal requirement that a minimum percentage of premiums must actually be used to pay for medical expenses (I believe 80 or 85%) so premiums are set accordingly. There are also income based subsidies that you're eligible for of your income is more than 4x the poverty level.
There was also an expansion of Medicaid eligibility up to 4x the poverty level with the additional cost being paid by the federal government, but some states have refused that expansion and money. This has left many poor in those states stuck unable to afford premiums and unable to get either subsidies or Medicaid.
I wish there was something similar to ACA for dental insurance. Most dental insurance plans on open market are expensive and with ridiculous terms, like 18-month waiting period! We had to take dental insurance plan through COBRA (almost 6 times as expensive as regular employee). Not sure what we will do with dental insurance after 18 months of coverage through COBRA.
It may be worth looking at how much you're paying each month in premiums and comparing that to the annual out-of-pocket cost for preventive / cleaning visits plus perhaps a filling or two. You may find that all the insurance is really doing is smoothing those payments out without saving you much money unless you have a "years of neglect" situation that you're still working through.
It's probably also worth asking your dentist if they have "self-pay" rates comparable to what they're getting from the insurance companies. If they bill $120 but accept $80 from insurance, will they take $80-90 cash from you instead of that $120? Also, for more expensive procedures like crowns, it's very likely that your dentist's office will let you do installments to spread the cost over at least several months. That doesn't really help when you don't have current income and aren't sure when you will have it, but it does relate to smoothing out your expenditures the way insurance premiums do.
I have a dentist friend whose practice doesn't accept any insurance so he is free to set his rates and charge his patient. After COBRA finishes we might go to him.
Worried about insurance for your kid? Can't happen here, the government will deal with that. Losing your job? Get paid for one or two years by your work insurance. After that you fall back to a free basic income (for as long as you need). And still this system is generally not exploited: People work hard here.
And it's not just unemployment. There are people begging for money on HN regularly, because they are dying (often of cancer) and are now worried about their families. This is just cruel and can't happen that easily on this side of the Atlantic.
But it seems US citizens want to live like that. Why?
After hearing this stuff for half a year I am really glad to be back in Germany. I am funemployed since a few months and I pay 150 euro per month. Next week I have an appointment at the doctor because of my severe hip problems. I might get some xrays done and perhaps some MRT. What will this cost me? Nothing! I am so glad that I live in a deeply communist country...
I was in Mexico partying with a bunch of US college kids when Obamacare was on the table, and we talked about it for a while. All of them said "We don't want it because it's Socialism!".
When I inquired as to what that meant, or why that is undesirable to them, the entire room of 30 of them went silent. Not a single one even know what Socialism meant, or why they had distaste for it, but they sure were certain they didn't want it!
IMHO, people in the US have been lied to for multiple generations, to the point where they don't even know why something is good or bad for them personally, they just know what they're supposed to think about something.
What they are thinking, but not saying, is:
"We don't want our tax money going to black people and Mexicans."
"Socialism" is a dog-whistle term that usually indicates racism when used in the US.
We also have heard many stories of people having to wait months if not years for non-emergency treatment. Such as getting an MRI for an injured knee in Canada for instance. As a very healthy avid runner it would be very frustrating to not be able to pay for something critical to me like that (once again I am not saying this is always or mostly the case but it is a scenario I have heard about). I suppose our imaginations extrapolate if health care is more or less free for all then our level of care will be much worse. I am not really sure.
If it was up to me, I'd kill all insurance companies with fire, have us all pay into a pot for medicare and just use that.
We just have such distrust in our government that we don't want them running the health care system. Witness, for example, the recent VA Hospital scandals. Our government is dysfunctional. And it's already incredibly intrusive, too, and some of us don't want the feds knowing all of our health problems (even though they probably already do).
I would love government health care, just not from this government. The free market doesn't work for health care.
> The free market doesn't work for health care.
Where is there a free market for health care that would could test this idea? Certainly not the USA.
I believe Singapore is the closest to free market healthcare and they seem pretty healthy. Though even that is not "free market" healthcare
Necessary conditions are that insurance is compulsory and that insurers cannot refuse coverage.
It should be obvious what would happen otherwise.
Well first, not all US citizens do.
Primarily this seems to stem from a free-market, conservative viewpoint. Central to this viewpoint is the thesis that not only is labor just, but the sociological outcome of labor is also, always, just (unless the government interferes). In other words, those who can afford healthcare have earned the right to it, those who can't were simply to lazy or ignorant to work hard enough to afford it.
Also, there can be a deep aversion to the government (any government) interfering with a person's property and income, where any program which requires people to give for the "greater good" is seen as not only theft, but an existential attack on the fundamental ideals of American individualism and personal liberty. The argument here is that governments are by definition corrupt, fascist and incompetent, and only a free market with as little regulation as possible could handle something like "healthcare" efficiently and fairly.
Therefore, advocates for limited government will see social programs as interference by an increasingly "big government" regime which has no right to force a moral imperative on people or relieve them of their property, and conservatives and free-market believers will feel that social programs undermine the moral principles of capitalism while insidiously creating a dependent class of lazy left-wing radical neo-immigrants.
Also, it's probably worth mentioning that not many Americans appreciate that there is a difference between liberalism, socialism and communism, and nor would they care.
http://www.economist.com/blogs/graphicdetail/2013/05/daily-c...
Becoming Germany, Britain or Sweden would probably be a tolerable tradeoff, but a lot of factors go into that, it's not something that happens as a result of a single policy or two. Do note that in Portugal the rich are worse off than the poor in the US, and Italy and even France aren't far off.
At least in theory, anyway...
Only "god" knows for sure, but I have a strong suspicion you answered your own question, at least in part:
> And still this system is generally not exploited: People work hard here.
This also shows Americans work more than the Germans and this doesn't say anything about how hard people are working, but don't forget the old adage: Don't work harder, don't smarter!
"Get paid for one or two years by your work insurance. After that you fall back to a free basic income (for as long as you need). And still this system is generally not exploited: People work hard here."
US citizens, in aggregate, want to live like that (or, perhaps more accurately, want other people in the US to have to live like that) when opinions are aggregated by effective political power, sure, but effective political power in the US is largely a function of wealth, which is extremely unequally distributed.
It used to be worse, of course. But even then it wasn't a disaster for the case at hand: the COBRA act allowed you to continue to buy your existing plan at the same premiums for a year and a half until you found a new job.
About the only good thing about COBRA is that it covers preexisting conditions.
When you're a COBRA customer you're basically on your own. Good luck getting them to pay up on anything.
Can we have a single-payer system now? Please?
I don't know what the differences would be if I were earning $0 per year, especially as the relevant question (on the form I filled out) was something like "How much do you anticipate earning this year?" which is a question I have no idea how I would answer if I were currently unemployed.
Your premiums would be $0. You would be immediately enrolled in medicaid.
And US health insurance is impossibly expensive because US health delivery is impossibly expensive. I believe 75% of the real US problem is not insurance, it is the cost of delivery.
Employers offer group plans which tend to be much cheaper and offer substantially better benefits than individual plans. The larger the company, the better the arrangement tends to be.
COBRA is designed to fill in that coverage gap when you leave, but as others have noted in this thread, it is not always economical.
In a rapid-churn economy like tech, where people often strike out on their own and companies cease to exist etc., the few $K a year it takes to maintain your own individual plan is something everyone should consider. As you age, starting a new private plan becomes frighteningly expensive, and if ACA doesn't stick, it may become impossible again for many people.
Couldn't find any good data but here's a post representative of the top few google hits for COBRA vs. private:
http://www.mymoneyblog.com/unemployed-cobra-vs-individual-he...
Is it possible you've had individual coverage in a state where such coverage is guaranteed-issue? That would account for a lack of distinction between group and individual rates.