Patients should control more of the funds that pay for their health care. Part of the rationale is consumers are better stewards of money than third party payers, but that is not the whole story. Patients could also purchase the care they prefer without the scrutiny of their health plan.
Under Obamacare patient power has only gotten worse. In 2023 I paid nearly $8,000 for a health plan that required I spend a similar amount on medical care before it paid a nickel of my medical bills. The only health care dollars I controlled were the ones I took from my own pocket. Of course, that is how it is supposed to work in other markets. The difference is that government regulates risk. If I want a method to limit my risk of a costly, catastrophic health condition, I must buy Obamacare. For 2026 the cheapest plan I can find is $975 per month for a $8,000 deductible. That means if I want to protect myself from the expense of a rare, but serious health risk, I must spend nearly $20,000 before my protection kicks in. However, if I buy any Obamacare plan, it will protect me against all medical expenses above an out-of-pocket maximum of $10,150, even beyond several million dollars. I am willing to pay for some of Obamacare’s protections but not all.
I would prefer to retain $10,000 of my $12,000 premium dollars and only pay an insurer to underwrite a risk that is between $20,000 and $200,000. I have no idea what that would cost. It may cost more than $2,000 as I suggested above. It may cost $5,000 but certainly would not cost $12,000. Moreover, if I were to apply to, say, Lloyd’s of London for a custom policy, the firm would undoubtedly want to see the results of a recent physical exam. Yet, I am not allowed to buy a health plan that better meets my needs from Lloyd’s of London, Aetna, UnitedHealthcare, Blue Cross or Cigna. The Affordable Care Act does not allow insurers to sell me an affordable, limited benefit plan based on my health risk.
What may I want to spend my health care dollars on? Fast Company reported on personalized medicine directed by dynamic monitoring.
People often take walking for granted. We just move, one step after another, without ever thinking about what it takes to make that happen. Yet every single step is an extraordinary act of coordination, driven by precise timing between spinal cord, brain, nerves, muscles, and joints.
Historically, people have used stopwatches, cameras, or trained eyes to assess walking and its deficits. However, recent technological advances such as motion capture, wearable sensors, and data science methods can record and quantify characteristics of step-by-step movement.
What does dynamic monitoring have to do with patient power? Simple: In an age when people can assess more aspects of their health status using technology, Obamacare will not pay for any of it. I could buy an Apple watch to monitor numerous aspects of my health, but no insurer would reimburse me for it. Health insurance does not pay for dietary supplements, peptides not ordered by a doctor, personal trainers, etc. Last year I paid $300 for a cancer screening test that looks for biomarkers for more than 20 cancers. It estimated my risk of cancer at 0.5% in 2025. Every year I get a comprehensive wellness screening that is not covered by health plans. It is currently on sale for $200. My Obamacare plan would not have covered that unless it was medically necessary, and my deductible was met. Ditto for the Metformin and microdose of a GLP-1 peptide I take for wellness. I can buy products to monitor my sleep and my cardiac function. I can even buy a pulse oximeter ring that monitors my oxygen intake in real time. Obamacare will not pay for any of the services I mentioned above because they are not treating illnesses. Obamacare is primarily a way to subsidize other people’s catastrophic care. About 90% of enrollees never reach their deductibles.
Health insurance is insurance against illness, not an investment in wellness. Traditional forms of health insurance were not designed for personalized medicine and dynamic monitoring. Obamacare is entirely obsolete.
Read more at Fast Company: How AI can monitor your movements to improve your health
You (and many others) are caught in what the insurance industry calls an “actuarial death spiral.”
In this condition, there are relatively few individuals who need the insurance.
I assume you are in a group of 60 year olds who are not in a corporate health plan and not in Medicare (for disability) and not on Medicaid for low income.
Of this smallish group, only the ones who already have heart disease etc. will keep the coverage as premiums rise. So the premiums rise even more.
You as a healthy person are insulted by these rates. So you look for other solutions.
When the ACA was designed, it had a mandate that was supposed to address this problem. The healthy people would have to stay in the program.
Good to hear from you Bob. Have you heard any estimates of the premiums if the individual mandate were still enforced? I expect it would be lower but I wonder how much lower? It’s limited to a 3-to-1 age band. I would think my age cohort would be a huge purchaser of Obamacare due to early retirees not yet eligible for Medicare.
comments from Douglas Holtz-Eakin….
Let’s take the president literally and imagine that all the subsidies being sent to insurers to cover Affordable Care Act (ACA) policyholders is, instead, sent in cash to the policyholders. Those policyholders with the greatest health needs will likely combine the government check with their own premium contribution and buy the same insurance. But some policyholders will not, especially if their health is good and they weren’t paying anything out of pocket to begin with.
Enrollment would drop, but especially so among the healthy. This is classic adverse selection; the remaining pool will be sicker and the premiums would have to rise. This would tend to drive out the remaining relatively healthy and the spiral would continue. At some point in the process, insurers would leave the ACA market. Eventually there would be some sort of residual high-risk pool serviced at high cost by a few insurers.
So, giving people cash will not work. One could deposit the subsidies in a Heath Saving Account (HSA), or equivalent, so that it would have to be spent on insurance and medical costs. Problem: Not every ACA policy has an HSA attached to it. One could create an HSA for each policyholder, but it would have to be more flexible than the current HSA, which is only attached to a catastrophic insurance policy. Not everyone buys a catastrophic policy, and for good reason. But if that is the system, then the money is going to BIG, BAD Banks, who then transfer it to BIG, BAD Insurance Companies. What has been accomplished?
Finally, the money could be put in a Flexible Spending Account (FSA) to cover the direct purchase of medical care. That solves the BIG, BAD Insurance Companies problem by essentially forcing everyone to self-insure and leaving them exposed to financial ruin from an expensive episode of acute care.
In the end, ObamaCare only “works” by throwing enough taxpayer money on the table to get millions insured at no expense to them. A better approach would be to get these individuals into the employer-sponsored insurance market, which has the added benefit of rewarding work. It is the road that should have been taken 15 years ago. Alas.