Perception vs. Reality: The State of the U.S. Health System

It appears Americans do not see a need for health care reform. Earlier this week Gallup released the results of its annual Health and Healthcare Poll. 

Health care was ranked the second most important issue to focus on in this country. It also ranked highly in the polls of 1993-94 and 2009-10. The pattern? Health care was in the news a lot during these times with the possibility of reform. It is in the news a lot now with the start of actual reform. And the kickoff of the reform has been less than stellar. This poll was conducted November 7-10 this year. By that point, Americans were already exposed to some pretty bad press in relation to the ACA. 

Let’s explore some of the specific findings. 

General Health Care
 Americans rate their own general health care higher than the overall nation’s (this result is on trend with those Gallup has received over the past decade in relation to this question). 

Cost 
Americans are satisfied with the cost of their own health care and view it as more reasonable that the general cost across the country. Although, the majority named cost “the most urgent health problem” in the country. So, I supposed Americans do see room for improvement here. 

Quality 
Quality was rated high in both cases. Seventy-nine percent were personally pleased with their quality, and 54% rated general quality across the country as good or excellent. 


Change is hard. Ignorance is bliss. It’s easier to stay in plans that we think are alright than to find out how sub-par aspects actually are. Compared to other countries, the U.S. doesn’t do too well in relation to these three topics. 

General Health Care
In a couple blog posts ago, I briefly discussed how the U.S. relates to other countries in term of general health care. Our perception doesn't match our reality.  The reality is less than satisfactory. 

 Cost 
“…The world’s richest country spends more of its money on health care while getting less than almost every other nation in return.” – Huffington Post 

“While there is room for improvement in every country, the U.S. stands out for not getting good value for its health care dollars, ranking last despite spending $7,290 per capita on health care in 2007 compared to the $3,837 spent per capita in the Netherlands, which ranked first overall.” -- Commonwealth Fund 

Quality 
In one of the comparisons I looked at, the Commonwealth Fund compared the health care systems of seven industrialized countries. They were rated on quality, efficiency, access to care, equity, and life quality and expectancy. The U.S. came in last overall. In terms of quality, we were a little better at a six out of seven. 

When breaking down quality, we came in 4th in regards to  effective care and patient-centered care. The factor that drove down our quality score was the ability to provide safe care. We are the worst at providing safe care. Personally, I consider this to be an essential when talking about quality. We spend more than we need to and can’t even expect to be safe in the end. In fact, procedures such as C-sections and colonoscopies are performed more often than they are actually needed so that more money can be made by the health care industry. Our safety is being risked for profit. 

The ACA offers consumer protections, so that things like this cannot happen.  Our government, media, and the health care industry need to do a better job educating Americans about the ACA so that our perceptions of our health care can meet and improve our reality.

A Success Story from Pittsburgh

A Pittsburgh woman was patient in her quest for new health coverage.  Gail Roach was paying $509/ month because of her pre-existing condition (Type 2 diabetes).  After attempting to search prices on the federal Marketplace, Roach called the phone number (1-800-318-2596). The person on the other end of the line found a plan for Roach that will cost $1.11/ month. 

ACA Benefits

ACA Health Care Plan Costs: Explanation and Examples

Example Pricing: Western Pennsylvania

 

Explanation of Graphics 

As you can see, each health insurance provider listed a plan for each of the metal levels which we discussed in the previous blog post.  You may also notice a “Catastrophic” option.  This is available to adults under 30 years old.  It is a very low monthly payment compared to the metal levels, but a higher out-of-pocket expense if the person needs something extra such as an emergency room visit.   

The Catastrophic plan allows for 3 primary care visits/ year with no added cost (compared to unlimited visits with the metal level plans) and must cover the essential health benefits which we covered in the Halloween post. 

Plan Pricing is based on four factors:

Age:

Before the ACA, older people were charged on average 5 times more for health insurance than younger people.  Under the ACA, seniors (age 64 or older) cannot be charged more than 3 times the rate of a younger person’s plan (age 21-63). 

Tobacco Use:

A smoker can be charged 50% more than a non-smoker.  Why would you ever disclose whether you’re a smoker then?  You can potentially lie about this to avoid the higher cost, but if your health claims start looking like you are a smoker, you may have to deal with the ramifications.  Many insurance companies had already begun this extra penalty about 10-15 years ago.

If you don’t want to pay the extra cost and you aren’t brave enough to lie, you do have another option.  As long as you are enrolled in a smoking cessation class (you don’t even have to quit smoking), you should not have to pay a higher cost. 

Family Size:

This depends on factors such as your combined household income (the total of what each member of your family is expected to make in 2014), family members’ ages, and their smoking habits. 

Geographic Area: States are split up into different geographic regions to create smaller, competitive markets so that prices can be reasonable for each region instead of overpriced.  Pennsylvania is divided into 9 different regions.  

Side Note: Plans that were created before March 2010 and remained unchanged in the past few years are “grandfathered” into the ACA.  These plans do not have to charge according to these four factors.  Plans created after this date had to change to fit ACA criteria.  President Obama has been catching heat because of these “grandfathered” plans.

 

Subsidy

Most Americans should receive a tax subsidy with the purchase of their plans.  Any individual making less than $45, 960 and any family making less than $94, 200 is supposed to get some sort of compensation to help them pay for their plans.  You can use the Kaiser Foundation’s Subsidy Calculator to get an estimate on what you might receive. 

A Word of Caution: I am a little worried, though.  Before the Marketplace opened and plan prices were still unknown, I was able to get a subsidy estimate for a 25-year-old non-smoker who made $30,000/ year.  Now, if I enter the same information, the subsidy comes up as $0.  The calculator figures this based upon a silver level plan.   

I am hoping that there is a subsidy for the bronze level plan or that the calculator is inaccurate.  I am not sure how many more “lies” or problems with the ACA the American people will put up with.  

If you are truly curious, I suggest you call 1-800-318-2596.  I imagine someone will be able to tell you what your subsidy would be.