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https://news.gallup.com/poll/186527/americans-government-hea...

> Americans' satisfaction with the way the healthcare system works for them varies by the type of insurance they have. Satisfaction is highest among those with veterans or military health insurance…




> Americans' satisfaction with the way the healthcare system works for them varies by the type of insurance they have. Satisfaction is highest among those with veterans or military health insurance…

Sounds about right to me. The VA health care system has problems [1] but on the whole doesn't seem worse than the rest of the US healthcare system, maybe better.

Anecdote: when my dad retired, my parents lost their insurance through his work, and my mom wasn't eligible for Medicare yet. They looked around at individual insurance options, which were horrible. My mom ended up using her VA benefits and was very glad to have them. The VA has treated my parents quite well, although the VA doesn't seem used to having a lot of female patients my mom's age.

[1] https://www.pbs.org/newshour/nation/veterans-affairs-backlog...


Wow. I am always stunned reading accounts like this.

I can't imagine living in a country where you loose health care when loosing a job or going into retirement.

I have to admit reading posts like yours makes me realize how lucky I feel with the German system.

And yes. I am well aware of the monthly costs that brings in terms of around 14% of my salary for health insurance. And of the limitations.

But to me this still sounds better than the risk of loosing everything due to an accident.

I am glad your parents found a way with your mom's benefits.


It's a terrible system, and it was more terrible before Obamacare.

In general when someone retires they're old enough to be eligible for Medicare (government-sponsored health care). My dad was. But my mom was just enough younger that she wasn't eligible for Medicare when he retired. There were (and still are) all kinds of weird gaps like this.


Obamacare created new gaps that absolutely sucked - made over 58k and self employed? No subsidies for you and paying a skyrocketing premium higher than any reasonable home mortgage with a 10k deductible. Completely unrealistic. And then the IRS hit you for thousands in penalties via the individual mandate.

I lived through that, uninsured, for five years or so as a business owner - to “rich” to get subsidies, too poor to afford 20k+ per year for nothing except a theoretical out-of-pocket max (I say theoretical because there are many exceptions, loopholes, and the annual reset). Being hammered by the IRS for this was.. just.. swell.

So for me Obamacare sucked because it made the cost of individual market plans completely unaffordable and then taxed me for not being able to afford it. As a business owner responsible for employing others, it seemed especially ridiculous because here was a strong disincentive for me to continue on, which would mean a negative ripple effect beyond just me, i.e. layoffs, if I shuttered the operation.

Once the individual mandate went away, and some new options for employer cost sharing like QSEHRA/ICHRA came about, it has gotten a bit more manageable, but most small business owners I know still struggle with healthcare. Cost sharing programs like CHM are about the only workable alternative but they don’t offer the kind of bankruptcy protection a solid insurance premium would cover, and they are religious by nature. Alternatively, DNR and a term life insurance policy.

Best option is to be married, have spouse work for the man to get into corporate group plan for family, while you grow your business enough to sustain an insurance scheme.

But it sucks out there on the individual market - the raw actuarial numbers to insure you are bad - and subsidies disappear quickly with any amount of AGI. Since the vast majority of Americans are on employer-paid healthcare plans, this is a view into it that most don’t see. The cynical side of me (as a small business owner) says this is by design to keep you working for corporate America - consolidation of labor, consolidation of the profits. For me, Obamacare further entrenched this aspect of the system, which has become more terrible, not less.


> and subsidies disappear quickly with any amount of AGI.

This has not been true for 2021 and is not true for 2022.

Your payments for health insurance are limited by a cap that is hard to explain, but basically, you should not be paying more than 8.5% of your AGI for the 2nd most expensive silver plan in your state.

I (self-employed) have an AGI in the mid-100k range, and these subsidies more or less reduced my wife and my insurance payments by half.

This system still sucks - we are paying private corporations, via government subsidy, for their overpriced goods and services. But from a numerical perspective, it's much closer to being inline with most of the rest of the industrialized world: 8-14% of income for health insurance that covers most stuff.

And in all likelihood, Congress will not renew it at the end of this year.


"Obamacare created new gaps that absolutely sucked - made over 58k and self employed? No subsidies for you and paying a skyrocketing premium higher than any reasonable home mortgage with a 10k deductible. Completely unrealistic. And then the IRS hit you for thousands in penalties via the individual mandate."

I am currently paying $800/mo for a "silver" plan in a state that did not accept the extended Medicare. No, I don't get subsidies. I believe my deducible is roughly $2000, although I don't know because all of my costs have been covered, including the trip to the emergency room after I wacked myself in the eye. (The out-of-pocket limit for 2022 is $8700 for an individual. (https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...))

Before the ACA, individual market plans were cheaper (although for the first couple of years they were comparable), but did not cover asthma (as a "pre-existing condition). Hello, $750 daily inhalers.


I see how this sucks for you.

Just out of curiosity I calculated roughly the cost in Germany. If you were self employed and made 5.000 € a month your health insurance would be somewhat around 900 € per month. Partly tax deductible if I am not mistaken.

So quite a bit of money. But probably manageable for many/most people.

I am lucky. As I only do freelance work on the side I am insured via what I pay from my main income. So no additional costs for me as long as I don't make more on the side than in my main job.


Premium costs vary by state. When I last looked (three years ago?) my bronze plan was $1600/mo with high deductible. It was higher than that six years ago. The affordability exemption started to alleviate me of the tax penalty once the exemption was available, and then the removal of the mandate removed the penalties entirely.


That's horrible, my sympathy. Personally, I think Obamacare fixed more than it broke, even immediately. In particular, it was a huge relief to get rid of the possibility you could be permanently uninsurable after even a tiny gap if you have a "pre-existing condition".

I wanted Medicare for everyone (still do), but politics...and lies about "government death panels"...


I want medicare for all (or at least wish that people could figure that out, in a workable way - probably not possible until international defense spending takes a huge haircut, meaning a very different world order), but I also don't think "death panels" are a lie - ignore the scary hyperbole, the point is that health care on a fixed budget needs to be rationed. The kind of plans we could offer the nation of 350m people without dramatic world-changing changes in budget structure would be pretty bare bones. That's a reality in all systems. None of us have a "right" to have endless repair services - we are "entitled" to services within the confines of the systems we create, pay for, and subscribe to. Limited budget, just like with NHS, means choices have to be made. Totally okay with that.


For what it’s worth, currently you can get a mid-tier Obamacare / ACA health insurance plan for no more than 8.5% of your income. It’s a big jump to have a new expense of 8.5% for sure, but we do have that option now.


Does that subsidy depend on what state you live in? AFAICT, it doesn't apply here in scenic Alabama.


From what I can tell, Alabama has all the regular subsidies for ACA plans. What they don’t have is Medicaid expansion. The federal government offers states money to expand Medicaid to anyone making less than the minimum needed for ACA plans. Some states like Alabama have refused the money and continue to only offer it to specific subgroups of low income people, usually only after they spent 100% of their assets also.


TRICARE is great. The VA: not so much.


https://www.rand.org/news/press/2018/04/26.html

RAND found that the VA typically also provides higher quality care.


The VA is much different than Tricare.




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