Obamacare Rationing by Price: Accident or Design?

Customers are imposing Obamacare rationing on themselves.

Obamacare chains

There were a couple of reasons given for the Affordable Care Act, one of which should lead us to expect Obamacare rationing. On the one hand, we were told that people were not able to afford needed medical care. On the other hand, we were told that people were spending too much on medical care and they needed to stop wasting resources (especially if they were old).

Now we find that people, who have insurance through Obamacare, are finding that they can’t afford medical care. The New York Times reports,

Patricia Wanderlich got insurance through the Affordable Care Act this year, and with good reason: She suffered a brain hemorrhage in 2011, spending weeks in a hospital intensive care unit, and has a second, smaller aneurysm that needs monitoring.

But her new plan has a $6,000 annual deductible, meaning that Ms. Wanderlich, who works part time at a landscaping company outside Chicago, has to pay for most of her medical services up to that amount. She is skipping this year’s brain scan and hoping for the best.

“To spend thousands of dollars just making sure it hasn’t grown?” said Ms. Wanderlich, 61. “I don’t have that money.”

About 7.3 million Americans are enrolled in private coverage through the Affordable Care Act marketplaces, and more than 80 percent qualified for federal subsidies to help with the cost of their monthly premiums. But many are still on the hook for deductibles that can top $5,000 for individuals and $10,000 for families — the trade-off, insurers say, for keeping premiums for the marketplace plans relatively low. The result is that some people — no firm data exists on how many — say they hesitate to use their new insurance because of the high out-of-pocket costs.

What this means is that people will basically pay insurance premiums and not get anything in return. If they avoid the doctor to avoid paying their deductible then they will probably never reach the point that the insurance company has to start helping them with expenses.

Insurers must cover certain preventive services, like immunizations, cholesterol checks and screening for breast and colon cancer, at no cost to the consumer if the provider is in their network. But for other services and items, like prescription drugs, marketplace customers often have to meet their deductible before insurance starts to help.

So this is what happened to, “If you like your doctor, you can keep your doctor.” It has become, “You can’t afford your doctor.”

[See also, “Ezekiel Emanuel Writes a Love Letter to Death Panels.”]

But was this an accident?—an unforeseen consequence? I have a hard time believing that. Basically, Obamacare has made people start self-rationing. They are being their own “death panel” now.

Seen in this light, Obamacare seems like a brilliant strategy. Monstrous but brilliant.