My Current Healthcare Crisis and Obamacare

First: My health is fine. My current Healthcare Crisis is that I, and my family, are currently uninsured. It is unclear how we will be able to afford health insurance.

Healthcare policy wonks discuss health care systems along three measures that are at tension with each other: cost, quality and access. The American health care system is the most expensive in the world, has either excellent or terrible quality depending on the criteria by which you measure it and access that is the worst among modern democratic countries. Our system fails two of these three measures.

There are a few things about me, my past life, my observations and my current situation that give me an uncommon perspective on healthcare policy:

• I am currently unemployed and cannot afford health insurance. Because of income I have already earned in 2017. I am not eligible for Obamacare subsidies and the cheapest insurance on the exchanges I am able to buy is $2015 per month! (See picture at top).
• I am eligible for COBRA but would have to pay $1632 per month to maintain coverage. My eligibility will expire in 18 months. I am not aware of any other options available to me.
• I would like to buy a very high deductible catastrophic health insurance policy with an annual deductible of $25,000 or more and a low monthly premium. But insurance policies like this are no longer available because of the Obamacare regulations of insurance markets.
• When I founded my company in January 2012, I was denied coverage on the individual market by two different insurance companies because of a pre-existing condition (Chronic Hemolytic Anemia). I was able to purchase health insurance through the Obamacare federal high-risk pool set up to operate in 2012 and 2013 prior to the exchanges coming online in 2014.
• In 2014 and 2015, I purchased health insurance on the exchanges. I sold my company in late 2015 and went to work for the acquiring company. In 2016, I received health insurer through my employer. I was laid off in February 2017.
• I am philosophically and temperamentally mostly libertarian. I don’t believe there is a “right” to healthcare. I also believe that markets should be the default means of allocating resources unless it can be demonstrated that markets fail to provide the needed goods or services or fail to meet an important societal goal.
• Health insurance markets in the United States have, historically, failed. Prior to Obamacare, our health insurance was great if you were employed and middle class or better. One of the “market” features of the pre-Obamacare system, at least in the individual market, was that it would hold down premiums because it specifically excluded people who were sick (because they were denied coverage) or poor (because they couldn’t afford it).
• Healthcare provided through an employer is not medically underwritten at the individual level but as a group. In other words, risks are pooled among all workers and premiums cannot be adjusted due to age or health status.
• Consistent with the above and with the objectives I outline below, I am in favor of some form of universal or near universal healthcare insurance program, not because it is a right but because, as a country, we can afford it. Especially if we get the policy and the structure of our system correct.

My experience, philosophy and biases lead me to suggest the following goals for any health care system we ought to pursue:

1. People with pre-existing conditions should be able to purchase health insurance.
2. Health insurance should be affordable independent of income, employment status or the condition of your health. If you are poor, unemployed, or have a chronic pre-existing condition you should be able to acquire health insurance.
3. Provision of health insurance should NOT be so tightly aligned with employment status.
4. Health insurance markets should be able to offer a range of options to the market from cheap, high deductible plans to more expensive “first dollar” plans that cover most care. Health insurance markets regulations established under Obamacare should be loosened.
5. Healthcare costs should be better controlled either through market mechanisms or government intervention or both.

So the big question is how do we get there? I will be publishing another essay soon with some ideas on how we might be able to meet the objectives laid out above.

Let me know your thoughts.