Looking Overseas Gives Us Reasons to Be Thankful for Obamacare

U.S. Adults Are More Likely to Skip Care and Struggle with Medical Bills Than Adults in Peer Countries

This Thanksgiving, a lot of Americans will be giving thanks for Obamacare.

By the end of this month, HealthCare.gov will be able to handle 800,000 users per day, enough to enroll everyone who needs coverage by the end of the year. Meanwhile, the state-run exchanges are reporting “a November enrollment surge,” precisely as the Obama administration predicted. (Massachusetts also experienced a late enrollment surge when they adopted an individual mandate in 2006.) Everyday, we hear new stories about Americans who are saving thousands of dollars on their insurance costs, including House Speaker John Boehner, whose new Obamacare insurance will cost pennies on the dollar of his six-figure income.

And not a moment too soon. Earlier this month, the nonpartisan Commonwealth Fund published the results of their latest survey of eleven industrialized countries, including the United States, where they asked people about their experiences with the health care system in the past year. Their findings are a sad reminder of just how bad the status quo is — and why we demanded health reform in the first place.

Many Americans don’t go to the doctor when they’re sick because they can’t afford it. Many don’t go to the pharmacy or take their medicine. Add it all up, and 37 percent of Americans had some sort of “cost-related access problem” in the past year.

That kind of problem isn’t nearly as common in the Netherlands, where it only affects 22 percent of the population. Or France, where the number drops to 18 percent. Or Canada, where it’s 13 percent. Or the UK, where it’s 4 percent.

Fair enough, you might say. More people have more access, but they also have to wait in line longer, right? Not necessarily.

In fact, in most countries, the majority of the population could see a doctor within a day of their request. The United States placed second-to-last in this category. A quarter of our population had to wait six days or more — a little better than Canada, but far worse than Australia, France, Germany, the Netherlands, New Zealand, and the UK.

But that’s primary care. The United States is known for its specialists, where 76 percent of the population got an appointment in less than four weeks and only 6 percent had to wait two months or more. That’s a heck of a lot better than Australia, where only 51 percent got an appointment in less than four weeks and 18 percent had to wait two months or more. Or Canada, where the numbers are 39 percent and 29 percent, respectively.

But it’s about the same as the Netherlands, where the numbers are 75 percent and 3 percent. And the UK, where they’re 80 percent and 7 percent. And even Germany isn’t far behind, at 72 percent and 10 percent.

So it’s a mixed bag, but we’re certainly not in the lead.

In most countries, it’s a lot easier to get after-hours care than in the United States. Only 35 percent of American doctors have an arrangement to take care of their patients after the office is closed — by far the lowest percentage of all the countries surveyed. In Canada, it’s 46 percent. In France, it’s 76 percent. In Germany, the Netherlands, and the UK, it’s 90 percent or higher.

And the doctors have a lot more problems in the United States, where the paperwork piles up. One in three — 32 percent — reported significant paperwork or payment problems in 2013, compared to 23 percent in France, 17 percent in Germany, 15 percent in Canada, and 4 percent in the UK.

No wonder everyone else is happier with their health care than we are.

Only 25 percent of Americans think their health system works well. In the other countries, that approval rating ranges from 40 percent in France to 63 percent in the UK.

Whereas 27 percent of Americans think the health system needs to be completely rebuilt, that disapproval rating ranges from 12 percent in Norway to 4 percent in the UK.

That’s a lot of numbers, but they all tell the same story: The United States has the most complicated, most expensive, and most frustrating health care system in the industrialized world — and none of that is due to Obamacare, most of which took effect after the survey.

In fact, Obamacare is moving our system closer to our international counterparts. Based on these numbers, I’d say that’s definitely something to be thankful for.

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An abbreviated version of this op-ed was published in Friday’s South Florida Sun-Sentinel. This version was published in the Huffington Post.

Reader Request: Who Will Benefit from ObamaCare?

CBO Estimates vs. Actual Obamacare Premiums

A reader asks: Under ObamaCare, what will happen to the millions of people who don’t file tax returns, are illegals, etc? Will there be more uninsured than before? Will this new law raise the cost of health insurance?

The individual mandate does not apply to undocumented immigrants, who are also ineligible for Medicaid and the subsidies available under the Affordable Care Act. To answer the question that’s really on your mind: The new law does not allocate any of your tax dollars to them.

Where it does allocate tax dollars is to American citizens and legal immigrants who cannot afford health insurance. It’s true that some of these folks don’t file federal income tax returns because they don’t earn enough income. (They still pay a lot, however, in state, local, and payroll taxes.) They will not be eligible for the subsidies offered on the new exchanges because those subsidies come in the form of tax credits. However, if they work for a company that has more than 50 employees, they will be able to receive health insurance from their employer. If not, their fate likely depends on geography. So far, about half of the states have chosen to expand Medicaid eligibility up to 133 percent of the poverty line, all of which will be covered by federal funding. If you’re poor and uninsured and you live in one of the states that refused to expand Medicaid, you’re S.O.L., as the kids say.

By the time the ACA is fully implemented a decade from now, the Congressional Budget Office projects that it will reduce the number of Americans without health insurance by 25 million, leaving 31 million uninsured. That’s not a complete solution, but it sure is a giant leap in the right direction. It will certainly save thousands of lives.

The CBO also predicted that the ACA will lower the cost of health insurance for the individual market, where the exchanges and subsidies are targeted. Critics latched onto the prediction that people will pay 10 to 12 percent more, but that’s a misleading statistic. They’ll be paying more because they’ll be receiving more. The CBO predicts that people will be able to afford better plans; hence, the higher cost. When they compared policies with the same quality, the CBO found that premiums will fall by 14 to 20 percent — and that doesn’t include the subsidies from the government that will make the plans even cheaper.

As it turned out, the CBO was wrong: Under ObamaCare, premiums are falling more than 20 percent!

The first evidence of this success came in May when California announced the premiums that insurers will be charging on the individual market exchange next year. Plans that were supposed to cost $400 to $500 per month are actually going to cost $200 to $300.

And in case you thought California was a fluke, New York just released its individual market premiums for 2014, and they’re going to be 50 percent lower than what they are now!

The New York rates are even more newsworthy because they prove that the individual mandate is essential and cannot be postponed.

In 1993, New York passed a law requiring insurers to charge everyone the same price. As I noted in my op-ed last week, without an individual mandate, this is a recipe for extremely high premiums because healthy people will choose not to buy insurance, leaving only the sick people who are willing to pay high rates because they need the insurance so badly.

That’s exactly what happened in New York. For two decades, they’ve had the highest insurance costs in the country. Currently, only 17,000 people purchase health insurance on their individual market.

But all that will change in 2014 for one reason and one reason only: ObamaCare. The individual mandate and the subsidies will bring healthy people into the market, spreading the costs of health care among less expensive patients.

It’s important to remember that we’re only talking about the individual market. If you get insurance from your employer or the government, these numbers don’t apply to you.

It’s also important to note that someone has to pay for those subsidies. This fact alone has caused some confusion, so let me add one more myth to last week’s listMyth #5: ObamaCare will force everyone to pay higher taxes.

There are a few new taxes under the ACA, like 10 percent on indoor tanning and a higher penalty on non-medical withdrawals from Healthcare Savings Accounts, but the majority of Americans will never have to pay these taxes. The only taxpayers who will definitely face a higher rate are the richest 2 percent, who earn more than $200,000.

In other words, the cost of ObamaCare is far less than its critics would have you believe.