America's health care system is in chaos. Or at least, imperfect. The president's signature HealthCare.gov site is riddled with problems and, so far, not enough young healthy people have signed up for insurance to offset the costs of caring for the old and the sick. Never mind that predictive models say the young procrastinate on enrolling.
If you've been following the news cycle, you probably read the stories about Obamacare's victims: the healthy, employed couples making $70,000 or $80,000 a year, just above the subsidy threshold for Obamacare, who now need to pay a bit more each year for insurance. If you live in New York or San Francisco, that may in fact feel like a hardship. But the reason that couples' insurance is more expensive now is because insurers are no longer able to discriminate against the less fortunate, driving up the costs for the relatively healthy and wealthy.
To put Obamacare victims' strife in perspective, let's take a trip down memory lane. You know, the golden years of American health care in … oh, let's say 2007, back when you could be denied coverage for something as benign as acne or as mundane as pregnancy.
Back then, anecdotes about people who were denied coverage abounded. They included this 12-year-old boy who died in 2007 from an abscessed tooth after his family's Medicaid lapsed. And this 17-year-old boy whose insurance was revoked after he tested positive for HIV. This woman who was denied coverage for breast cancer because she wasn't diagnosed at the correct clinic. And this woman whose double mastectomy was denied after her insurance company learned she had visited a dermatologist for acne treatment the year before. Ah, yes, those were the days!
For those who put more stock in headlines, here are a few that help convey the state of the American health care system back in its heyday.
From The Washington Post in 2009: "Acne, Pregnancy Among Disqualifying Conditions." From the Associated Press that same year: "Worker Health Care Costs Soar." From USA Today in 2007: "People Left Holding Bag When Policies Revoked." And from The New York Times in 2004: "Cost of Benefits Cited as Factor in Slump in Jobs." And in 2002: "Hard Decisions for Employers as Costs Soar in Health Care."
Of course headlines and anecdotes are a horrible way to explain health care policy. For those of you who want a more thorough jogging of your memory, here's a roundup of some of the wonkier stories.
From the Harvard Business Review in November: "In 1980, the national expenditure on health care in the United States was just over 9% of Gross Domestic Product. Today it accounts for nearly twice that — close to 18%.… Health insurance premiums rose four and half times faster than the rate of inflation over the same period."
From Kaiser Health News in 2009: "Employers struggling with the steady rise of health insurance costs -- which in 2009 increased 5 percent to an average of $13,375 for family coverage -- are passing on more of the expense to their workers through higher deductibles and co-payments, according to survey released today."
From McClatchy in 2009: "The average cost of job-based family health insurance climbed 5 percent to $13,375 in 2009, making this the 10th straight year that health care premiums have increased faster than workers' wages and overall inflation have. Insurance costs have increased 131 percent since 1999 ... that supercharged growth rate far outpaces the 38 percent increase in wages and 28 percent growth of inflation over the same period."
From The New York Times in 2008: "Since the recession of 2001, the employee's average cost of an annual health care premium for family coverage has nearly doubled — to $3,300, up from $1,800 — while incomes have come nowhere close to keeping up. Factor in other out-of-pocket medical costs, and the portion of the average American household's income that goes toward health care has risen about 12 percent, according to the consulting and accounting firm Deloitte, and is now approaching one-fifth of the average household's spending."
For those partial to studies, there's no shortage!
From Kaiser Health News in 2013: "Currently, about one in five plans sold to consumers makes them responsible for at least half their medical costs after they've paid their premiums and met their deductibles, according to an analysis of government data by U.S. News & World Report and Kaiser Health News."
From the Commonwealth Fund in 2012: "Most adults who try to buy plans in the individual insurance market find it difficult to compare plans and find affordable coverage."
From Academy Health in 2011: "On average, premiums for people who stayed in individual market plans for more than a year went up 15% per year."
From the Health And Human Services Department in 2011: "According to a new analysis by the Department of Health and Human Services, 50 to 129 million (19 to 50 percent of) non-elderly Americans have some type of pre-existing health condition … without the Affordable Care Act, such conditions limit the ability to obtain affordable health insurance if they become self-employed, take a job with a company that does not offer coverage, or experience a change in life circumstance, such as divorce, retirement, or moving to a different state."
From the Commonwealth Fund in 2009: "On average, small firms pay up to 18 percent more in premiums than large firms do for the same health insurance policy."
And for anyone looking for an explanation in one chart, there's this: