Americans frequently boast that we have the best health care in the world. While that may be debated in some quarters, no one doubts that our health care system is the most expensive. What makes American health care so pricey, and is there anything that could be done about it?

Evaluating Obamacare

One approach that has garnered a lot of attention is the Affordable Care Act, also known as Obamacare. It has been five years since this became law. How well are we doing with it? Our guests discuss the pros and cons of Obamacare from different angles.

This Week’s Guests:

Stephen Brill is an award-winning journalist, a lawyer and author of America’s Bitter Pill: Money, Politics, Back Room Deals and the Fight to Fix our Broken Health Care System. 

Jonathan Oberlander, PhD, is professor of social medicine and health policy and management at the University of North Carolina at Chapel Hill. His book is The Political Life of Medicare. The photo is of Dr. Oberlander.

Listen to the Podcast

The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free for four weeks after the date of broadcast. After that time has passed, digital downloads are available for $2.99. CDs may be purchased at any time after broadcast for $9.99.

Please feel free to tell us your reactions to this show, where it says “What Do You Think?” below. Because this topic is more political than most of our shows, we ask you to read our commenting policy and stick to civil discourse. Thank you.

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  1. Alton

    The assertion that Medicare is eventually going to disappear because of a lack of funds is absurd. Furthermore, in a “wealthy society” such ours, there should be no such thing as people without medical insurance coverage! Yes, we are wealthy! Where did the money go and where is it now? It is in the hands of the top 1% of the citizens of this country. It is time that our tax rate system was adjusted so that the top 1% can provide some assistance to the country that “brought them to the dance”!

    When the available ticket supply for theatre shows, sporting events and other forms of entertainment is continuously sold out while people are still homeless, children and families are without food and our country’s infrastructure is falling apart, there is something wrong. I could go on and on by comparing the tax rates/structure of the 1950’s with the current rates/structure and pointing out that there is a flawed cap on the payroll tax, etc., etc., but I will not go on.

    Also, we should follow what other countries are doing regarding health care for everyone and regulations of health care costs. It is all the fault of our U.S. Congress!!

  2. Ciya

    Very interesting conversation. Please don’t do the voices. Funny but may be offensive to some.

  3. Donna

    Last year, we went through several job changes, etc. and with no insurance signed up for Obama Care….we were on it four months, qualifying for a subsidy…we finally landed on our feet with better income and went to the employer insurance, cancelled our Obama Care….at tax time, it did NOT matter that those 4 months we lived on nothing and were scraping by…..the end of the year income dictated that we must pay the subsidy back, regardless of the fact that we QUALIFIED to be on it during the four months….so anyone getting extra hours, a raise, a better paying job, etc. will find out at tax time you have to pay some or all of it back, we ended up owing $1259.00 to the IRS.

  4. Denise

    I work in a diagnostic imaging center. What I see is the poor are getting better care but the working poor and seniors are really hurting. High deductibles are making people postpone seeing a doctor which can lead to more complex treatment and added cost.

  5. John

    Obama care has changed Medicare for the worse too. Copays for Part D have increased dramatically. Doctors can no longer perform tests that they used to do routinely but no longer are paid for by Medicare. The Administration took money from Medicare to fund the program for others. Seems everybody loses except those who receive subsidies equal to the cost of their health care.

  6. Susan

    I have always seemed to fall into the “working poor” category. I made enough money to live in a very modest rented home and only the essentials. I cannot afford ANY health care premiums, In Dec. I was diagnosed with colon cancer. Right now I am wading thru. the horrendous disability process. I have a stack of bills that reach over $100,000. This year I have no income at all, so I do not have to get Obamacare. For 2014 tax return, I filed for exemption due to not being able to afford the coverage at my job or thru Obamacare. The Affordable Healthcare is NOT affordable for anyone. If I had it, I would not be able to afford the deductibles or co-pays…even with subsidies….I would be paying the insurance company and have no healthcare at all. I think the insurance companies are what needs to go. PS: When the boss of our small company thought he might have to quit offering coverage, employees in my office were CRYING because they could not afford Obamacare. Fortunately the boss decided to pay the additional $100/employee to keep group coverage. The employee’s share also went up $100 each, but this was FAR cheaper than the alternative.

  7. J. David Auner
    Springfield, MO, USA

    Brill’s comments about unsustainable cost of ‘health” care in the US are correct and very important. The main reason for the difference in cost between Germany and the US is not from too many tests as Brill asserts (it is some of the difference along with too much invested capital in revenue producing machines;) there are just too many hogs overfeeding at the trough of “other people’s” money. Billionaire healthcare and pharmaceutical execs, multimillionaire hospital execs and subspecialists, millionaire proceduralists, huge jury verdicts and attorneys’ fees on lucrative cases – these folks don’t just want to visit Europe, they want their own villas and to purchase Luxembourg. There is a lot to do to create a healthcare system and we have a do nothing Congress in the way.

  8. Diane

    Just had a colonoscopy covered by my private insurance. Polyps were found and quickly removed. The cost was almost $6000. Everybody I told this to were shocked at the outrageous price.

  9. jcd

    The cost for health care in our country is a very big problem. I think we can reduce those costs significantly by eliminating the middleman (ins. co.) and adopting a universal system such as medicare as most other advanced countries have done. We can also cut costs by allowing people to become Doctors (gp’s) at no cost to themselves. After graduating they must serve for at least 3 yrs. where needed. We can then adopt a salary system for remuneration rather than a fee for service system.

  10. David
    Greensboro, NC

    I love your show, but on Saturday, I was screaming at my radio. Your guest had no clue as to the true cost of Obamacare. There is no free lunch as any fool knows. There already was a shortage of doctors and anyone on Medicare (another forced government program) was already having difficulty getting a doctor to see them. My supplemental premium tripled and my wife (5 years younger) had her premium increased 400% with much worse coverage. Of course, if your insurance is “free” then you think it is wonderful. But again, there is no free! We all have to have serious skin in the game for the system to work. Name me one thing the government has done right. Medicare and Social Security are both bankrupt (we just are not fully informed as yet) and we have a national debt that we may never get free of. Pray the rest of the world never calls our bluff on the real value of the dollar. Thanks for all you do.

  11. Glenn
    Wilmington, NC

    I’m a psychologist in private practice. My Obamacare premiums have gone up by about $5,000. year, with a doubling of the deductible, plus zero coverage for even routine benefits like an annual physical. Consequently, what I’ve done is increase my prices to patients who have no insurance, or when they have a policy that won’t cover my services, so my fees have become less affordable and more people now go without. Plus, when insurance does cover my services, but my patients now have a deductible of $5,000 -$12,000., and so the patient is responsible for the entire cost of my work, they say, “I can’t afford it” and cancel the appointment. Tell me how this is ‘Affordable Care’? What has resulted is that people have INSURANCE but they do not have health CARE. Wow, what a deal, an expensive piece of paper in their wallet they can’t afford to use.

    • J. David Auner

      the insurance companies wrote the part of the law which gives them all the income and rare payment risk. When you have a government for sale this kind of rip-off happens. In SW MO there is no competition in the plans – there appears to be collusion on benefits, deductibles and prices – surprise.

    • Birdie
      Seattle, WA

      Respectfully, the people that are living in the states who have elected Republican representation and refused the healthcare subsidy are the ones that are suffering. Blame your state representative. People who live in states that accepted the subsidy now have VERY affordable insurance that covers much more than old policies that covered absolutely nothing. I have had the best healthcare of my life, and the most affordable since “Obama care”. I am from N.C. but live in WA state. For the first time in my life, I can go to the doctor and not worry that I will lose everything.

  12. Birdie
    Burien, WA

    I am a former NC resident that feels extremely lucky to live in WA State where we took the subsidy for O’bama care. The under-served, lower income citizens of states that are republican represented whom refused the subsidy are the ones that are suffering at this point and time. Low income citizens should blame their elected state representative if they are not eligible for extended medicade due to income being too low to qualify. That is your elected officials fault for not taking poor people into consideration when it comes to affordable insurance.

    I know the system is not perfect (it NEVER has been and it has NEVER been fair to lower-middle income earners!) and it will have to change to become sustainable but it saved MY families life. I have been self employed for 10 years. I was a self employed housekeeper and have been a designer for the last 4 or so years. I have always purchased my own insurance. It was always expensive, a high deductible, and covered NOTHING. For years my family has crossed their fingers that nothing horrible would happen. We had some small health issues that cost us thousands and thousands of dollars, with “GOOD” insurance, before “Obamacare”. When I would go to the doctor, the insurance company would do everything in their power to not cover anything. The hospitals have always charged insane “list” prices that would only have a small part covered by insurance… WE would have to cover the remainder of the huge sum…

    Then “Obama” care came along. To our amazement, we qualified for the expanded medicade the first year. It was hard to hear that we made so little that we would qualify but we took it and dropped our other expensive insurance. All of my friends and family had great insurance plans through their corporate jobs. They work less hours than I, pay nothing for prescriptions, and had no problems with the way things WERE. Of course they wouldn’t, they were covered.

    Well, a couple of months after we got the expanded medicade, my husband had to go into the hospital, was in intensive care for 4 days, transferred hospitals in an ambulance and needed extended time off from our business. Guess what… we paid NOTHING for this! Obama care saved my family and kept us from losing everything we have worked so hard for. My old “good” insurance would have bled us for the rest of our lives. We didn’t qualify for medicade this year as we have made more money and our business is doing great but we do have a very affordable plan with a private insurance company through the exchanges. It is not perfect but so far, is much more affordable and covers lots more than our former insurance before Obama care came along. It is the cheapest plan that we could find and it offers MUCH more than our old expensive plan.

    I feel like I can actually go to the doctor and not be scared that I will pay for it for the rest of my life. I want to thank Obama for changing everything and making the playing field a little bit more even for everyone. If you have complaints, now you see how it feels for all of the rest of us that had to cover everything ourselves… and on 1/2 or more of the amount of money that a middle class earner is making.

  13. Tom
    Pinehurst, NC

    I am a physician that accepts Medicare and Medicaid patients.
    I have these thoughts:
    If ALL my patients were Medicare I would have to close my doors since their payment is 50 cents on the dollar, or less.
    Secondly, why did the ACA not address Medical Malpractice costs?
    Thirdly, Medicare’s reimbursement has not kept pace with inflation-their increase has been 1/2 of 1 % yearly while I give my staff 3% cost of living increases yearly. Other costs of doing business have risen even more!
    I could go on and on but bottom line-Obama care is doomed to failure and will be replaced, eventually, by a single payer system run by the Government and we will all get what we pay for.

    • jeri

      I certainly hope so doctor. Exactly what we need is Medicare for ALL. Taxed to pay for it. Worked in England. Until the government decided to emulate the American failures and privatize the NHS. I compare my English mother in law and my own mother here in u.s. living in identical circumstances on meager pensions. You’re right that medicare needs better funded. And yes we all deserve health care. Thank you for your caring thoughts.

      • J. David Auner

        Medicare spends far north of 10K per year on every person covered (not counting Medicaid coverage of Nursing Home and prescriptions for those with that additional coverage or co-insurance which is frequently taxpayer subsidized.) Some interesting stats show up, half of Medicare patients don’t use any service in a year. The services to those heavier users seem to be wasted on futile care for dying patients. One million dollars, at least, was spent on my father’s demise after he had presented with metastatic adenocarcinoma of the lung. None of the treatment benefitted him much. We need a better system, with less money spent.

        • Tom

          Then address my second point of fear of lawsuits from unrealistic families that DEMAND expensive, though futile, care.

  14. Jon
    RDU, NC

    I have both BCBSNC and Medicare. My BCBSNC premiums (and copays for both devices & especially medications) continue to skyrocket, while my benefits continue to decrease. Both my BCBSNC & Medicare EOB’s are almost always non-sensical. My partner’s Medicaid (disability — waiting for heart transplant) is always in question (by the State of NC) and was canceled during a glitch in their system, through no fault of his) causing him to miss an available heart. Yes. The health care system in the USA is sadly, horribly broken and needs a total revamp to a viable system that is equal and free for all.

  15. Rosie
    United States

    I am 60, very healthy, and self-employed. In the years before ObamaCare I purchased catastrophic type policies. My out of pocket maximum (deductible) was $5200. I received an annual physical including blood panel, pap, and mammogram at no cost. At 58 years old it was costing me $204 and I had the option to donate to a HSA.
    Then Obama care….and I was not allowed to have a catastrophic policy because of my age. My choices of policies cost me $2.5x or more of what my old policy cost with a $3750 deductible, and no HSA. I had a benefit of an annual physical as before but the only blood test included was for Cholesterol. I was eligible for a subsidy based on my income. So while I pay about what I did before ObamaCare, I realize less benefit.
    So I am not happy. My income is going up so next year I doubt I will be eligible for a subsidy so will have to pay perhaps 3x what I would have before ObamaCare, will not have the choices in insurance that I used to (catastrophic policies) which suit my needs. I think the ones benefiting from this system is the insurance companies who have raised premiums and have many more customers because of the requirements. Granted it is good that more people are insured …is it because we are paying for it not only through our taxes and increased premiums for us who already buy insurance?
    This is not “affordable health care” yet.

  16. Bonnie
    United States

    From my vantage point “Obama Care” has been a God-send to many people. As an example, my 40 year old daughter, college grad, worked in the family business for 10 years. She found that she had a passion for helping people and decided to become a Nurse’s Aid specializing in Alzheimer’s. She works in homes 40 hours weekly at $10 per hour. There is little left after rent, car payment, etc. for health care. This new government program allows her to not worry if she should become ill. My neighbor was working 2 jobs to make ends meet and has a pre-existing illness. She now is able to have the necessary surgery on her feet to allow her to continue working thanks to Obama Care. PS: I was a Republican!

  17. Ted L.
    Salem, Va

    The problem with the Affordable Health Care is the cost. Most people who are employed in general do not feel the cost of healthcare insurance directly. I am 60 years old. My wife and I are retired and we pay over a $1000 a month for Healthcare. We are healthy people. I feel we are paying for other folks Healthcare. The problem I have with that is it’s not my choice. 2nd, we get punished for being somewhat successful and have invested wisely and saved our money for retirement. Due to our retirement income we have to pay more. I feel that it is a hidden tax in a different form that insurance companies benefit from. Now, we are being punished for being successful.

    There are many folks my age that are working only because they can’t pay the for Healthcare. Someone needs to make a political issue out of the cost and not the care. Seems if Healthcare were a free market. Much of the cost could be removed if the insurance was eliminated. Clearly, insurance companies have to make money and they are the middleman.

    • Birdie

      I paid almost $400 dollars a month as a self employed 30 year old who was completely healthy. What you may not understand is when you pay insurance, you don’t pay for yourself. You pay into a pool that helps not only yourself, but everyone else in that pool who is sick or not.

  18. Penny H.
    7101 Meadow Park N, NRH, TX 76180

    I just returned from visiting my podiatrist. Of all the doctors I have now, she is the one I trust to tell it like it is so I asked her what was going on with all the “new rule changes”. She practically exploded. She told me that for 2014 alone her practice group prescribed 1,500 pairs of diabetic shoes. Each prescription was audited by Medicare, the Affordable Care Act or the Drug Enforcement Agency. The paperwork alone amounted to more than two or three inches, not to mention all the man hours to a point that the practice is considering not prescribing diabetic shoes any more. And this year the situation has gotten even worse. For instance your PCP has to have a diabetes diagnosis using the exact same wording as your podiatrist, must have seen you within the last six months (in case your diabetes has gone away) and you PCP will be audited too, making sure that everyone is complying.
    I asked if this was happening to other doctors (pain specialists, rheumatologists, neurologists, etc.) and she said that all physicians were feeling the pinch and many were thinking about getting out altogether. That means it will be even harder to find a decent doctor. And, like my doctor, many are getting fed up and refusing to do the “required” paperwork to practice effectively.
    One reason I brought this up with my doctor is that I have been having increasing difficulty in getting prescriptions filled. Not just my Vicodin, but something as innocuous as my diabetes testing strips. It took me nearly 5 months to get my new shoes, three weeks to get thyroid medicine, three weeks to get those diabetes testing strips, and over a week to get some medicine to replace a prescription because the pharmacy switched manufacturers and the new brand didn’t work at all.
    I have always thought that the two guys who saddled us Medicare recipients with the donut hole should be hung on the capitol dome by a very sensitive part of their anatomy. Now I think they, or their first cousins, are at it again. The motto seems to be Screw the Seniors or at least make life so difficult that they drop dead from frustration and stress.
    I don’t have an answer. If anyone has a suggestion – feel free.

    • Tom
      United States

      You are experiencing how the “Medicare Advantage Plans” can afford to “pay” for all the things included in your plan – they deny coverage.
      It is well known that about 50% of people denied coverage never appeal the denial, thus saving the insurance company a lot of money.
      This is one of the things that is bad about a single payer system- despite what many people feel that it is the best system around.

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