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.

Four Myths — and the Truth! — About the Individual Mandate

Obamacare Individual Mandate Penalty

Last week, the Obama administration announced that it was delaying the “employer mandate” in the Affordable Care Act, the part that requires large employers to provide health insurance to their employees. The employer mandate was supposed to take effect in 2014. Now, it’s scheduled to begin in 2015.

This week, Congressional Republicans have responded by demanding that the “individual mandate” be postponed a year as well. This proposal has prompted a debate filled with misunderstandings and misleading propaganda. Here’s the truth behind the myths…

Myth #1: Next year, everyone who doesn’t have health insurance will have to pay a $2,000 penalty.

The most basic problem with the individual mandate is that no one seems to know exactly what it is. I’ve heard people throw out all sorts of numbers, most of which make it sound more expensive than it really is.

Here’s what the ACA actually says: Next year, in 2014, every adult who doesn’t have health insurance will have to pay a $95 penalty. Every child will have to pay $47.50. If you file taxes as a family instead of an individual, the penalty is $285 or 1 percent of your family’s income, whichever is greater.

That’s a far cry from $2,000.

In 2015, the penalty goes up to $325 for adults, $162.50 for children, and $975 or 2 percent of income for families. In 2016, it reaches its peak of $695 for adults, $347.50 for children, and $2,085 or 2.5 percent of income for families. That’s probably where the $2,000 figure came from. As you can see, it’s not nearly as burdensome in the proper context.

Myth #2: The individual mandate can be postponed with little or no negative consequences.

Beginning on January 1, 2014, insurance companies will no longer be able to charge different premiums to different consumers based on health status, a.k.a. “pre-existing conditions.” The only factors they can consider in setting premiums are geography, age, tobacco use, and individual versus family plans.

They cannot charge women more than men. They cannot charge sick consumers more than healthy ones. They cannot charge you more if you work in an industry that happens to have higher health care costs. They cannot raise your premium if you’ve gotten sick while you’ve been on their plan.

This is one of the most popular parts of the ACA. It appeals to our sense of basic fairness. Most Americans consider it an outrage that insurers have been discriminating against women and the sick.

But there’s a problem with these new rules: If insurers charge the same premiums for healthy and sick people, the healthy ones can no longer pay the cheaper rates they’ve been used to. As a result, they won’t buy insurance, leaving only the sick people in the pool. Sick people are expensive for insurers. They receive more health care than they pay for. Insurers will have to raise premiums in what is known as a “death spiral,” making insurance unaffordable for everyone.

That’s why we need the individual mandate. In order for these new rules to work, everyone has to buy insurance, including healthy people. If Congressional Republicans get their way and postpone the individual mandate, we could be looking at astronomically high insurance premiums in 2014.

Myth #3: The individual mandate was first invented and proposed by Democrats.

In October 1989, the conservative Heritage Foundation, a leading Republican think tank, published the first policy paper proposing an individual mandate. In November 1993, Republican Senator John H. Chafee introduced the first bill in Congress that contained an individual mandate. The bill had 18 Republican co-sponsors.

The individual mandate was a Republican invention from a time when it was not yet heresy for a Republican politician to advocate providing affordable health insurance to every American without a government takeover of the industry.

Myth #4: The individual mandate is socialized insurance.

Why are we still talking about Canada and England? Just the other day, I received an email from a Republican reader reciting the problems with government-run health insurance. So what? ObamaCare is nothing like the Canadian or British system.

The individual mandate requires Americans to buy private insurance. That’s why insurance companies have posted double-digit gains on the stock market since the ACA became law. The values of Aetna and UnitedHealth have nearly doubled in only three years.

In fact, no major American politician is proposing a government-run system. Like it or not, private insurance will be around for a long time to come. The only question is, will everyone be able to afford it?

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An abbreviated version of this op-ed was published in yesterday’s South Florida Sun-Sentinel.

Off With His Head!

by Norman Horowitz

Bruce had promised his wife Blanche that he would be on time for a very important family function, and of course he is late. Blanche flies into an absolute rage and vilifies him endlessly. When she calms down, he tells her that he was late because he was having sex with his mistress, and that she would not let him leave, and that he wanted a divorce.

As Blanche begins to cry, Bruce tells her that he made up the business with the girlfriend to point out how nuts she had become about his tardiness and how unimportant it was.

In a similar way, the Brits have gone bonkers over a News Corporation transgression that took place in the UK.

Yes, News Corp. did a horrid thing. And yes, they should be punished. But not Rupert Murdoch.

Murdoch has admitted that a cover-up took place within the News of the World to hide the scope of the phone hacking.

The British Parliament released a report concluding that Murdoch “exhibited willful blindness to what was going on in his companies and publications” and stated that he was “not a fit person to exercise the stewardship of a major international company.”

I disagree.

Many years ago, I did business with Murdoch and have met with him a few times. I hold him in the highest esteem for assembling a gigantic media empire and doing it with an integrity that was unknown in Hollywood for decades. (It was certainly absent at the studios where I worked). I have never worked for News Corp., but I have known many of their senior people and have never had reason to question their integrity.

I joined MGM/UA in the mid-1980s with responsibilities over a variety of media segments. We uncovered a relatively significant defalcation, and the individual involved left the company. Should my Chairman have been forced to resign because of this? I think not. He was not involved in the crime, and he had no reason to have known that it had taken place.

Similarly, during my tenure at Columbia Pictures, there was a major defalcation, yet the management was not called upon to fall on its sword.

Indeed, many of the studios and major production companies have tolerated criminal activities in their own company rather than risk the scandal that disclosure would entail. I can “name names,” but no one has ever seemed interested.

So, while I believe that News Corp. should be punished, I do not expect that Rupert Murdoch be held responsible for the actions of a few overly zealous employees.