> But I can't imagine what people have to sacrifice to keep any kind of coverage (with high deductible and horrible coinsurance and prescription drug coverage) for their families if they don't have a decent income :(

These increases are specifically a lapse in subsidies for high earners -- those with a "decent income." People under 400% of Federal Poverty Level still qualify for the subsidies. And it's a relatively recent policy change to roll back; we didn't have this subsidy from 2010-2020.

You go without coverage of course. Unfortunately.

(It's getting late, Jeff. I'm heading to bed myself.)

I'm so, so sorry to hear this. Can you share which state you're in?

Excuse me, but how in the world were you able to afford 1200/month, you know that's like cheap rent right?

You're still allowed to visit the same PCP although it might not be covered, or covered out-of-network with a higher patient responsibility.

Yes to both. High costs were previously partly hidden by subsidies for some consumers purchasing individual or family policies on state ACA exchanges, and now many of them will be forced to pay something closer to the true market price. But just like with college tuition, when the government throws money at a problem that ends up causing costs to explode without permanently improving affordability.

It's always cost ~$2k a month, the only difference is the previous administration thought everyone else should be "temporarily" paying for her plan.

I feel like we need a perpetual PSA here that moving money from person A to person B obviously doesn't make anything cheaper.

Guy from Poland here. What happened to ObamaCare? I thought you got finally a primary healthcare for all?

Corrupt congress people will vote down any such proposals.

Both. Also there's a culture of infinite consumption of medical services.

I'm confident a surgeon in America is paid more than 100$ for a surgery. They are paid about 400k a year on average. Do the math yourself.

On the other hand you provided no details as to where the money actually goes. It's not a simple proble, and part of the problem is that our doctors are paid a lot more than in peer nations

Bullshit. Even Medicare will pay a surgeon about $600 for CPT code 44970 and commercial health plans are higher than that.

This is misleading.

Health insurance premiums cost about as much as buying a new car every year. Healthcare is generally on top of those premium payments.

PE is a convenient whipping boy but it's not the main problem. There has been so much consolidation of health systems and other provider organizations in some regions that they now effectively have monopolies, allowing them to jack up prices. The effect is largely the same whether the owner is a PE firm or a non-profit foundation. In order to counteract that we would need much more vigorous antitrust enforcement, which doesn't seem politically likely.

What did the ACA require that shouldn't be part of healthcare in one the wealthiest countries in the world?

Annual check ups? Cancer screenings? Maternity care? Basic mental health? Forcing the insurance companies to accept patients with preexisting conditions?

These services should be available to everyone.

If a developed country cannot provide these things to its citizens it's a failing state in my book.

> laundry list of

That’s a meaningless statement, look for an actual percentage here.

Healthcare costs have been spiraling for decades in the US, the ACA didn’t impact the long term trends to a noticeable degree. Actual healthcare reform could drive down costs massively, but that would mean a fuck load of people in medical billing getting laid off. Instead you’re paying for your doctor to talk with your insurance provider often for longer than they spend working with you, that’s the ultimate issue with US healthcare costs. Inflation adjusted “healthcare” spending is up from 2,100$/person in 1970 to 14,570 in 2023.

https://www.healthsystemtracker.org/chart-collection/u-s-spe...

You don't need it until you need it, and needing it often comes in the form of a lightning strike from blue sky. The counterargument is that having everyone pay a higher amount makes it feasible to actually have this coverage available, when needed, without bankrupting the insurance companies, because the rare astronomically expensive care is covered by the premiums paid by the vast majority of people who are relatively healthy and are unlikely to need it.

Now whether the on-paper prices for medical care in this country actually have any relationship to objective reality is an entirely separate question of course. In general coming from an outside perspective, combining healthcare and for-profit motives in a single system seems particularly likely to lead to all kinds of perverse incentives, but, it's the system that exists, and it seems unlikely to change any time soon.

That’s how insurance works. You pay for a plan you likely don’t need so everyone older than you is reasonably covered.

If young people elected to get a barebones plan while in good health, who would subsidize them when they grow older?

The main point of health insurance is to cover things that most people don't need. Prior to the ACA, most health plans had lifetime coverage limits which could leave patients with serious conditions financially ruined or unable to access care. The ACA removed those limits so naturally coverage is now more expensive.

This is factually incorrect and in fact the opposite of what a Cadillac plan means.

Obamacare plans are actually the opposite: they are high deductible with limited networks.

Obamacare plans typically have deductibles between $5,000 to $9,000, with a narrow selection of networks, and high premiums if unsubsidized.

This is the opposite of what a a Cadillac plan is (or used to be).

Have you been on an ACA bronze plan? I wouldn’t consider it a Cadillac plan nor did I find it covering lots of unnecessary things.

Which are the specific things you think most people don't need coverage for? Prior to the ACA, it was pretty common to hear stories of people not on employer plans who were shocked to discover a coverage gap they have. Most people don't have much expertise in evaluating healthcare coverage and deciding which services they might need.

> The end result is we all have Cadillac plans that most people don't need.

That's right, those pesky things the ACA says should be covered like emergency services, ambulances and prescription drugs is definitely the issue here. You've definitely found the problem.

I can't believe people keep repeating this lie. Did no one live prior to the ACA where you could easily go bankrupt because your insurance decided it didn't cover things like hospital bills? Because I sure as fuck remember, considering that's what bankrupted my parents.

If you have a high paying job in the US it usually comes with legitimate health insurance paid for by your employer, meaning most of the cost of most healthcare is covered.

If you don’t you pay a lot. Before ACA non-group plans generally didn’t cover any health conditions that predated your coverage.

ACA was just good enough to cool down demands for a true public health plan while also being just shitty enough to turn everyone else off to ever wanting one. Essentially the perfect way to prevent a public option for generations.

You should go tell that to the waiters who are working for tips.

Reads a bit like you’re in a bubble. I have friends in the States who work in education, construction, and hospitality. I similarly have friends working in those fields in EU. I’d say the ones in EU are better off _and_ don’t worry about healthcare.

Not to mention you get actual vacation time in Europe and a higher standard of living generally.