It was good to get your feedback about the Affordable Care Act summary I wrote. I agree that it's still confusing, even with it broken down the way I have it. I promise I will return to it and make it simpler as it becomes clearer to me. I'm afraid, though, that it will never be simple enough because of the politics around making that legislation happen in the first place. The bottom line for you will be that it means no change because you already have health insurance through your union that I'm positive covers the minimum that the ACA covers and you are not an hourly employee. You might get even more preventive services with no co-pay because of the new regulations.
We talk a lot about why health care is so expensive and I'm sure we're not getting bored with it because it's very complicated. I was pretty excited when I came across John Green's explanation of the system. I think he's able to talk about it clearly in part because he's not a health care researcher. Also, he's way funnier than I am when I talk about it.
So in the US, we spend about $245 billion per year just on diabetes care. This is a lot, but it's especially a lot when we consider that in 2007 it was only $174 billion. In contrast, in the UK diabetes care costs about £14 billion (about $22,400 billion USD), Canada spends about $12 billion CDN (about $11.6 billion USD), and Australia spends about $10.3 billion AUD (about 21.5 billion USD). None of this should be surprising after hearing Green talk about the overall massive differences in health care spending.
The UK, Canada, and Australia all have some form of universal health care, which means that basic health care is funded through taxes and administered through a centralized system. Countries differ about how much people pay for medications and supplies, but since those costs are much lower to begin with, the out of pocket costs for people with diabetes is lower than in the US. It is hard to pin down figures because the systems all report things differently, but considering that in the US individuals with diabetes incur about $7,900 worth of expenses directly related to the disease and that health care coverage is so varied, it is safe to say that it's a lot more expensive to live healthfully with diabetes in the US than other leading industrialized nations.
All of the issues that Green brings up are absolutely part of the problem of the expensiveness of diabetes care in the US. Getting back to the question I raised last time about the effects that the ACA will have on out-of-pocket diabetes costs, I still don't think it will make any difference for people who have already been insured mostly because even with increasing access to health insurance, since the payors (private insurance companies and Medicare/Medicaid) are not centralized, folks who do not qualify for government benefits will not benefit from the economy of scale (negotiation of prices for massive contracts) that Green was talking about. We will also continue to have huge inefficiencies in the system and high administrative costs because there are differences in billing, coverage, reimbursement, etc., so I don't think the ACA is going to do anything to reduce the cost of health care in the bigger picture, because it is not in the interest of the health care industry to cut its profits.
I'm glad that the out-of-pocket costs are manageable for you and that you have a union that has advocated for you and your coworkers. Not all union members are in as good a position, though, since there are some unintended consequences that might hurt them. As much as I hate to say this, I am grateful that your coverage is already through a for-profit insurance company.
Love,
Mel
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