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Sara Foss's Thinking It Through
by Sara Foss

Thinking It Through

A Daily Gazette life blog
Her column and blog rolled into one

Obamacare still raises plenty of questions

When I broke my wrist five years ago, I became friendly with an uninsured, self-employed woman who broke her wrist around the same time I did, and we decided to discuss our experiences over coffee.
At the time, she was wondering how she would ever pay the $25,000 bill she had received for her wrist surgery. I was confounded. Under my private insurance plan, I had been billed $25 — the cost of my cast — for the exact same procedure.
There’s a strong chance this woman now has health insurance.
Under Obamacare, uninsured individuals were required to apply for insurance by March 31, or face a penalty. According to figures released this week by the state Department of Health, more than 908,000 New Yorkers have enrolled in health insurance plans through the state’s website. About 421,883 enrolled in private plans, while 486,689 signed up for Medicaid. More than 70 percent of enrollees were previously uninsured.
So far, the research suggests that Obamacare is having an impact.
According to a Gallup poll released on Monday, the percentage of Americans without health insurance has dropped to 15.6 percent, the lowest rate in almost six years. And a study by the RAND Corp. estimates that 9.3 million more people had health insurance in March than last September — a surge driven by enrollment in plans purchased online, as well as increased enrollment in employer-sponsored insurance and Medicaid.
I’m glad people are obtaining health insurance, and the possibility of better medical care when they need it. Even the healthiest of people will inevitably get sick or hurt, as I discovered when I landed in the emergency room with a broken wrist.
That said, there are still a lot of unanswered questions about how Obamacare is working — whether it is providing the quality, affordable insurance people were promised. And there are still a lot of problems with health care in America — problems the Affordable Care Act is unlikely to address.
The ACA won’t address the fact that health-insurance premiums for job-based coverage have risen 196 percent since 1999, with worker contributions growing 182 percent, according to Kaiser Family News. Nor will it address the
fact that the average family plan cost $16,000 in 2013, and that workers paid an average of $4,565 toward that cost — a figure that doesn’t even include what they paid in co-payments or deductibles. It won’t address the fact that health insurance premiums rose 4 percent in 2013, while wages rose a paltry 1.8 percent.
Such findings explain why I’m skeptical when people suggest that Obamacare is responsible for rising health care costs. The cost of health insurance has been rising for years. It’s a trend that predates health care reform that has been going on since I entered the workforce, if not before.
In 2011, the U.S. spent $8,508 on health care per person. The next closest country, Canada, spent $4,522. Germany spent $4,495. France spent $4,111.
Data like this only seems justified if you regard the rest of the world’s industrialized countries as provincial backwaters where the doctors are a bunch of incompetent hacks. But I don’t think that’s the case.
My sister received great medical care when she fell and hit her head in London — a catastrophic accident that resulted in her spending over a week in an intensive-care unit with a coma, undergoing brain surgery and being flown back to the United States in an air ambulance. My parents did give the hospital a small amount of money, but my guess is that most Americans would pay a lot more for comparable treatment in the United States, despite having health insurance.
I’m not alone in questioning why the U.S. health care system is so much pricier and difficult to deal with than in other First World countries.
In an essay for Reuters earlier this year, former business writer Anya Schiffrin described how much easier it was to navigate the French health care system, where her father was treated for cancer, than deal with doctors and insurance companies in New York City.
“Every time I sit on hold now with the billing department of my New York doctors and insurance company, I think back to all the things French health care got right,” Schiffrin writes. “The simplicity of that system meant that all our energy could be spent on one thing: caring for my father.”
Again, I’m glad more New Yorkers have health insurance.
It’s good for them, and good for people who already have insurance, too.
When the uninsured are unable to pay their bills, those costs are passed along to people who have insurance in the form of higher premiums. And when people forgo health care because they can’t afford it, they risk higher health care costs down the road.
But let’s not forget what health insurance is: a ticket to an unwieldy, complicated system with a lot of flaws.
Reach Gazette columnist Sara Foss at or 395-3193. Opinions expressed here are her own and not necessarily the newspaper’s. Her blog is at

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