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The true costs of Obamacare

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POSTED March 30, 2013 2:14 a.m.

Those of us who live in California woke up to some pretty scary headlines this week. According to a new report, Obamacare could result in increases of 30 percent in health care premiums.

Thirty percent!

Of course, even without Obamacare, premiums have been going through the roof. But 30 percent for the same health care you’ve been getting? It’s enough to send chills down the backs of even the staunchest Obama supporters.

Except that it isn’t quite right. It isn’t just the devil that’s in the details.

First of all, the numbers only apply to the 2 million folks who buy health care as individuals or will when the law goes into effect, not the 19 million people covered by their employers. Everyone agrees that the impact on plans covering large groups of employees will be much less.

Second, those who make less than 400 percent of the federal poverty line ($46,000 for individuals, $94,000 for a family of four) will actually pay about 47 percent less for coverage because of federal subsidies.

Third, 30 percent is the headline, not the real number. The new plans will offer people more and better benefits with lower deductibles, which means that families will actually save more and get more for their coverage. Those who are paying 30 percent more in premiums will be saving one-third of that because of better coverage and lower deductibles.

As many of us know, there’s health insurance, and there’s health insurance. I have many friends who could only find (not to mention afford) the skimpiest of policies, which exclude everything from prescription drugs to mental health. In order to comply with new federal requirements, everyone is entitled to “essential health benefits,” which even many who are insured don’t get today.

Fourth, a big factor in the increase is that people who, for all intents and purposes, can’t even buy insurance today, let alone good insurance, will be able to do so. That brings sicker people into the system, rather than leaving them in line at the emergency room — which, by the way, is not only the most expensive place to get care, but also one the rest of us pay for in other ways.

When I asked a friend to explain what looked to me like an outrageous hospital bill, including charges for everyday items I could have bought for half as much at the drug store, the answer was simple: The cost of “my” supplies effectively included the cost of services and supplies for those who could never pay for them.

Fifth, the cost of care is going up anyway. Without Obamacare, healthier folks who can buy insurance (as opposed to those with pre-existing conditions who are turned away) would be paying about 10 percent more in premiums anyway. And that’s with no guarantee of prescription drug coverage or mental health services and the like.

Sixth, and most important, the issue here is not just money; it’s also values.

I have told this story before and have heard similar ones countless times from friends, acquaintances and folks in line at the market. Some years ago, I went out to buy health insurance for the woman who has, for the past 25 years, taken care of my children, my dogs and me. I insisted that she be covered. All I can say is thank God for Kaiser. No one else would take my money. Why? Because she had gastritis. Seriously. Because they aren’t looking to add 50-somethings to their books — because they might get sick. Of course. And she did, years later, get sick, and frankly, without insurance, good insurance, doctors who gave her world-class treatment, she would not be here.

The bottom line, for me anyway, is this: There is no such thing as a free lunch. Providing good health care for every American is not something we can do for free. But it is something we should do. And we will. And once we do, as was true of Medicare, it will be difficult to imagine that it ever could have been otherwise.

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