Sorry…if these people get sick what is their self reliant plan? Wait 8 years and go to Med school and become a doctor?
They don’t have coverage and are paying a penalty because of that.
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Pay a doctor to treat them? Insurance isn’t some requirement for paying your bills.
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Sure seeing s PCP is cheap and easy. But there is no way someone who qualifies for a subsidy is paying for chemo, or a bypass, or a few nights in the hospital or diabetic supplies. They probably can’t pay for labor and delivery. These millions of people are magically never getting sick?
In my personal experience that’s not the way it works either. We went pretty far trying to sign everyone up out here when ACA coverage started. Hosted in house sign ups by bilingual coveredca licensed reps. At the end of the day and after 3 rounds (years) of this we had less than 10% of people take us up on it.
Part of the presentation was a discussion of the subsidy, the penalty and the coverage costs.
These were not libertarian or conservatives who fundamentally disagreed with the spirit of the law. They just didn’t see a need and don’t care. They were/are pretty much judgement proof and will continue to get their care from a combination of low cost clinics (where they do pay their bills) and county medical services if/when something major hits.
They think theybwill sign up when they need the coverage and if they can’t…they’ll just show up for care and not pay the bill.
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I wasn’t entirely speaking of poor people when I was reading the above comment about being self reliant. Obviously your degree of ability to pay depends on your means.
Clinics aren’t a bad value for poor people, but yeah, it’s hard to get judgment proof people to do anything responsible if they don’t want to - what are you going to do - throw them in jail or deny them health care at the ER if they don’t pay cash up front? It’s like how society doesn’t have the spine to punish welfare recipients who commit welfare fraud for extra undeserved benefits by cutting them off entirely so it’s basically risk free for them to try.
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If it was just a $200 doctor bill then there wouldn’t be a discussion to have in the first place.
The problem is the $200,000 doctor bills.
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Figure 3 lists reasons for not being insured
Only 2% of people say they have ‘no need for health coverage’
#1 reason for 45% of people is that they can’t afford it. Losing a job, losing medicaid, not having employer provided insurance and change in family status are the other top reasons.
(edit : I’m not sure why thats bold/large text and I can’t find a way to fix it)
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Lemmings just can’t help themselves from jumping off cliffs.
They are a bigger problem, certainly. It’s worth getting some perspective on this by observing that most of the world doesn’t make $200k in their lifetime, and they get some level of medical care when they get sick with many of the same health issues (unless they’re completely destitute). At some point, you have to decide that paying $200k for some procedure, potentially useful as it may be, is a luxury. We don’t have to force everyone to pay for these, either for themselves or for others. It’s a value judgment, and even if it’s the difference between living a bit longer or dying, there’s some level of expense where that doesn’t make sense (or at the very least, such a person making that decision shouldn’t be subsidized for making that choice since society views it as a poor use of limited resources).
From the Kaiser article, the 45% of people uninsured from the quote say “the cost is too high”, which is different than “I can’t afford it.”
In 2016, 45% of uninsured nonelderly adults said they were uninsured because the cost is too high
I want free insurance too, but at the unsubsidized prices they charge for ACA plans, I would be inclined to go without since the cost is too high for the value. That’s a different statement than thinking I just won’t need any care at all (which might be true of young adults). The article also cites that 1/5 of nonelderly uninsured adults make over 400% FPL, which means they are almost certainly choosing to not pay for insurance as a value judgment.
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1/3 of Americans end up with Cancer.
You think its a luxury that we try to keep those people alive?
good point. Its unclear how many of those people refuse to buy it because its not a good deal. I’m, sure 1-2% of them think that way.
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I probably thought this as well at one time. But seeing topics like the following have changed my mind:
https://www.bogleheads.org/forum/viewtopic.php?f=2&t=231429
From reading the above linked discussion, it appears that people who have retired early and are too young for Medicare can manipulate their income so they qualify for the subsidies. This doesn’t mean they’re poor or even desperately need the subsidies. They could have a 7 figure net worth and be able to afford the full premiums and/or out-of-pocket costs for medical care. All they have to do is show low amounts of income on their 1040, whether taxable or tax-exempt, and they can get subsidies that make their premiums less than what my husband pays for our family coverage through his employer!
(Disclaimer: I’m not a Boglehead. I’ve recently started browsing their forums because of my interest in a topic that caught my attention there, not related to this particular discussion.)
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Thank you for the link, fascinating to read.
My comment was speaking to the people who don’t have coverage and could qualify for a subsidy.
The bogleheads seem to want coverage and are actively seeking ways to get a subsidy and sign up.
Are you saying we should have means testing? 
At some cost and prognosis, yes. the only question is what price do you draw the line between reasonable and excessive. I’d rather have incentives in our healthcare system such that patients and/or doctors aren’t encouraged to make the most expensive choices since they’re spending the taxpayer’s money instead of the patient’s in such cases. In the long run, we’re all dead regardless of how much money we waste on healthcare.
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Seriously, I don’t like the idea of that. I also don’t like the idea of subsidies, at least not to the extent that some are getting them.
Someone gets a subsidy of over $1000 a month while another person has to pay almost the same for their monthly premiums because they don’t qualify for a subsidy. People claim that less than $100 difference in annual 1040 income can make that much of a difference.
I can’t blame someone for taking advantage of the system. I blame the politicians who designed the system. They can’t seem to imagine these unintended consequences.
It is means-tested, at least to the extent your income is correlated with wealth, and using taxable income is the easiest way to administer it.
I’m sure they never intended for it to be applicable to the tiny subset of rich retired people with taxable income low enough for the subsidy. I can’t imagine there being that many. Most people would rather make 100k and pay up for health insurance than to make 30k and get it free.
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Agree with your math, wholeheartedly.
It would be relatively easy, with enough planning, to engineer the 1040 income to be below the level to get the subsidies.
True, but if you’re rich and retired, most likely you are over 65 and have Medicare not Obamacare. Why do people think Medicare is fine but Obamacare isn’t when the main difference is mostly age eligibility.
And price, and value for dollar, and network acceptance, and… There a tons of reasons Medicare is better than Obamacare but the main root difference is Medicare covers everyone in a given age group and isn’t optional. There is no adverse selection causing super high costs and the associated tortured gyrations by the politicians and insurers to disguise those via subsidies, taxpayer bailouts, degrading network and care quality, etc.
if Obamacare forced all the government workers and employer plans to use it too, it would proabably work reasonably well, but trying to socialize the cost of the “bad luck” of the few with expensive health issues onto a mere 5-10% of the population in the individual non-group health market is a recipe for the disaster we’ve been watching unfold for the past 3-4 years.
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So then why not just eliminate the age requirement and have Medicare cover everybody? Instead of you or your employer paying $1000 a month to Blue Cross, pay half that to Medicare since efficiencies of scale would reduce costs.
That could not be more wrong.
Medicare is a non-profit single-payer. The ACA is merely a marketplace on which for-profit private-sector health insurance corporations sell their products.
There would be some issues, but broadly “Medicare for all” is not an unreasonable approach if you want a single payer system.
Generally, I think a free market tends to give you a better more efficient setup (do you want you healthcare with all the timeliness, efficiency and bedside manner of the local DMV?), but you need to have the regulators do their jobs and set the incentives correctly. Currently, the lack of pricing transparency given the layers of insurance companies and various care provider agreements is one of the major impediments to an efficient market.