re: Personal Stories of ACA in WV, powerful article

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What's the minimum threshold for having skin in the game?

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I don't know, but since the ACA kicked in I was paying over 21K a year for health insurance on the Mrs. and I for a plan with high deductibles and I was still paying my fair share of taxes.

I'm lucky I can afford that, but my kids can't.

And I know others that just quit buying insurance because the deductible was so high they'd never get to use it unless things were catastrophic and since they were single with no kids they just elected to roll the dice.

And then you read in the news that they need another ER in BR because its too far for people to travel since they closed their old one here. People are still using the ER for basic treatment with or without the ACA.

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What's the minimum threshold for having skin in the game? Most able-bodied people on Medicaid have jobs

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Well for one this man you made up obviously has a job as you stated he's part of a group plan. Therefore his paycheck will have a section on it where it states how much he pays for healthcare. That's called having skin in the game.

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The moral of your story is frick insurance companies. There's only two ways to drive down health insurance costs in the long run. One is by eliminating private health insurance altogether with single payer. The other way is by introducing public option which would create competition for private health insurance companies and force them to lower costs.

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Blaming insurance companies, hospitals, doctors, nurses, drug companies, pharmacies, and medical equipment manufacturers is a red herring!

The reason for high health care costs is two fold: the economic nature of the demand for medical care and government. The nature of the economic demand just is as a force of human nature. It's not good or bad; it's just normal and natural. Government intervention however comes closest to being a force of evil!

There are two types of demand. Most demand curves are elastic (look it up or buy an economics book). This is predicated on the existence of choice at different price points (competition of substitutes). For example, you need transportation to work- buy a Ferrari! Can't afford the Ferrari? Then buy a Surburban, or an Accord, or a Focus, or a scooter, or a bike, or use the bus, or just move closer to work and walk!

But how about medical care? You need an operation that cost the same as the Ferrari. Can't afford the operation? Then maybe you can buy a medicine that can slow the progress of your condition, or maybe you can buy a medicine to reduce your pain, or maybe you can buy a medical device to reduce your disability, or you can live with the pain or disability, or you can just die! Wow that sure results in a different demand (inelastic). Come hell or high water your going to try to buy that Ferrari!

With everyone wanting to avoid pain, disability, and death there is high demand for Ferrari health care. Almost everyone wants to make and profit from that sale! No one wants to buy the bike bandaids and few want to make them. When faced with death in reality, the patient couldn't care less about the theoretical cost.

So what determines the cost of health care is the limit of what payer is able and willing to pay! Can you afford it, or would you perhaps prefer to give your money to your progeny? How about your family, friends (church sales, go fund me, blood donations, etc), how much a group is willing to pay for an insurance plan, the willingness of a charity, the willingness of taxpayers for government. As then sentence progressed the ability to pay increases and the willingness to pay decreases. But each level has a maximum to it's ability to pay. Europe and its socialized medicine is there.

Europeans no longer pay more, so they ration medical care with rationing and cost capping. So you need to get an imaging scan? Wait in line 6 months because the budget limits how many we could buy. Oops your cancer progressed and it is now incurable. We cannot waste limited chemo drugs or valuable hospital resources or limited doctors time on a lost cause. We will humanely give you medication to ease your passing starting with aspirin and working our way up in cost and effectiveness. Europe concentrates on rationing not innovation. Even their medical industries depend upon American profits and to a lesser extent the world's wealthy to pay for their new products.

The only way to reduce costs is to freeze medical technological progress! The only way to do that is to reduce the availability of money to pharmaceutical companies and medical device manufacturers through government fiat or taxes (like Obamacare!), or let the free market settle it down.

I prefer free enterprise because that allows the most personal control of my family's future. We determine how hard to study, what we study, the field to go into, how long and hard we work, how we spend and save, and ultimately what we can afford now and in the future from doctors to transportation. Governments come and go and my one vote has a minuscule impact on its controls on my life and family.

Government healthcare promises a Ferrari in every driveway for the cost of a Smart for 2! But when you figure in the cost of government inefficiency you'll end up with a bike!