As a Canadian medical student, it's worth keeping an eye on other healthcare systems. They can be a source of inspiration when advocating for changes to our own system, as well as a warning when other changes are being considered here that have not worked well elsewhere.
The US has a reasonably effective, but highly unequal and terribly inefficient healthcare system. This has been true for decades. It was true before Obamacare came in, it's been true since Obamacare was implemented, and it seems likely to be true in the near future as well. However, changes are on the horizon. US Republicans have made opposition to Obamacare to be a defining element of their party policy and they now have near-full authority to alter the American healthcare landscape as they collectively see fit.
In that light, I've become intrigued by this AskReddit thread I recently stumbled across, "US residents of Reddit: How will the repeal of the Affordable Care Act affect you...positively or negatively?". While hardly scientific, this kind of personal feedback offers a fairly unique glimpse into the effects of healthcare policy on individuals in real-time.
The answers seem to be falling into two categories, revealing both the strengths and weaknesses of Obamacare. On the beneficial side, there are numerous stories of individuals with significant, long-term medical conditions who would be medically or financially crippled without Obamacare. These individuals would be denied care or be forced to pay insurance costs effectively on par with their extensive medical costs if Obamacare didn't exist. In extreme cases, they would face bankruptcy or premature death due to these financial burdens.
On the other side is people, often younger individuals or families, facing insurance bills that eat up a substantial portion of their income and provide little benefit given their current health. The figures here are obscene in some cases, hundreds of dollars per month with high deductibles. Together, these conditions mean the insurance is useless for the day-to-day medical expenses of generally healthy individuals, functioning only as expensive disaster insurance in the case of an accident or unexpected illness.
These two outcomes are directly related. Obamacare's primary goal was to increase coverage, particularly for individuals with pre-existing conditions. These people have medical costs beyond what they can afford in insurance payments. To afford to cover them, premiums had to rise on other, healthier individuals. That's not very helpful for those healthier people, especially those without much money, as the cost of insurance goes up for them without any gain in benefits. So, some will choose to drop their health insurance, rightfully determining that the cost of maintaining their insurance is not worth their premiums. To prevent this logic from causing a spiral of higher costs and more people dropping out of the market, Obamacare mandated that everyone buy insurance. That means younger, healthier people buying health insurance more expensive than their needs to cover the costs of sicker, typically older individuals who pay less than their needs.
Virtually every country's healthcare system involves some form of these transfers, from the young and healthy to the older and sicker. It's effectively a requirement for a functioning healthcare system. The anecdotes from the AskReddit thread are therefore entirely unsurprising in general features - to move towards universal care, the proportion of medical costs covered by healthy individuals will almost certainly increase, in order to lower costs on sicker individuals.
However, there is a problem in scale and precision unique to the US. American healthcare is terribly inefficient, costing far more than comparable countries. The premiums quoted for healthy individuals in the AskReddit thread are beyond what they could be or would be in other systems. Likewise, the burden of covering the costs is falling disproportionally on lower-income individuals relative to other countries. To put this in perspective, under the American system, I would have to buy the same insurance this year that I'm in school, with no income, as I would next year with a solidly middle-class salary, and then again when I'm a practicing physician in a few years with an upper class income. By contrast, in Canada, my healthcare costs would vary significantly with my income via taxes. Obamacare put some subsidies in to help balance things out, but these have proved to be inadequate in many cases.
Obamacare was deeply flawed and the AskReddit thread exemplifies who those flaws have affected unfairly. Republicans are eager to fix this problem of overly high costs for relatively healthy individuals and it seems clear that this can be accomplished. Whether they will pursue policies that satisfy that goal, without causing additional, more serious problems as a result, remains to be seen.
No comments:
Post a Comment