Hi I'm Dr Aaron Carroll. And in this new youtube show we are going to try and help you under stand how medical
research and health policy work. We are going to make sense of a lot of the confusing information
in the world, and we are going to have a lot of fun doing it.
We are officially launching in a few weeks, but today, we're going to give you a little
preview., and talk to you about Obamacare. So I have this friend that is a little bit
of a hypochondriac, his name is John Green., and he's been asking me a lot of panicked
questions about Obamacare.
John: Wait Aaron I heard the cost of my families insurance is going to triple in the next year?.
Aaron: No
John: Well my uncle told me his medicare is being taken away, thats true, right?
Aaron: That's not going to happen.
John: Alright Aaron, what about this? I heard that under Obamacare medications are now going
to have side effects.
Aaron: That was already the case.
John: I just got this email from a friend who said under Obamacare anyone over the age
of 45 will be euthanized.
Aaron: Wow, absolutely not. John: Also, that reminds me, I just got an
email about someone whose lupus was cured by Aliens. Why don't we just get our healthcare
from Aliens? Aaron: Well I suppose...wait NO thats not
how we get healthcare.
Okay, clearly we need to start with the basics. Let's talk about what Obamacare is, and what
it isn't. And what changes are in store for you.
Health Care triage Although Obamacare was passed in 2010, the
big pieces of the law are scheduled to go into effect on October 1st, just days from
now. But what does that mean to you? Will your insurance change? Will you still be able
to get medical care? If you don't have insurance right now, how will you get it? No matter
what you think of the law politically it in your best interest to get as much out of it
as you can. So today we are going to explain how Obamacare works, and how it will affect
you. (Over 47,000,000 Americans were uninsured
in 2012) For decades the most glaring problem in the
United States healthcare system has been that millions of people are uninsured. We are one
of the few industrialized countries in the world that doesn't provide universal coverage
to its citizens. Here is a list of some of them that do. For the past few years the number
of people that lack any coverage for a year has hovered around 50 million people. Is that
list still scrolling? We'll wait. By the way all of those countries are democracies, they
all voted to get that universal coverage.
Lots of people don't have insurance because they have some form of chronic illness. That's
not a surprise, because I mean come on, if you're already sick, what insurance company
would want to cover you? And if they do, the policy that they will give you will likely
cost a fortune. And that's a whole other problem, health insurance is really really expensive.
Last year the average employer sponsored health insurance policy cost almost $6000 for an
individual. The average plan for a family, cost more than $16,000. The average 2 bedroom
apartment rents for about $12,500. I'm just saying, thats too much money for many americans
to afford. The architects of Obamacare had a number of
very straightforward goals. The first was to make sure that no one could be denied insurance
if they wanted to buy it. This idea is called guaranteed issue. The second is that people
should all be charged a similar amount, even if they have a chronic condition. They shouldn't
be punished for being sick. This idea is called community ratings. That's not to be confused
with the TV show community's low ratings, which are infuriating cause that show is awesome.
These are the major thrusts of Obamacare's regulations, but there is a problem here.
If you make it so noone can be denied a plan if they want it, and no one can be forced
to pay more if they're sick; there's no reason for health people to buy insurance. They can
just wait until they get sick, and then they can go buy a plan for the same amount that
they could have before they got sick. But if only sick people buy insurance, then the
price of premiums go way up. This leads to even more health people to skip buying a plan,
only sick people are left, price goes up even more, more healthy people opt out, and we
get what we call a death spiral for the private insurance industry. Which while it sounds
really cool, we really don't want that to happen.
To avoid this, we need to come up with a way to convince healthy people to buy insurance.
One way it to charge people a penalty if they don't. Obamacare handles this by charging
people a fine of $95 or 1% of their income if they don't buy insurance. That's the individual
mandate, but that creates one more problem. Who do you make people pay for something if
they can't afford it? One way would be to subsidize it. And people who make less that
400% of the poverty line, will get a tax credit from federal government to help them pay for
the insurance. These are the subsidies of Obamacare.
These three factors , the regulations, the individual mandate, and the subsidies from
the three-legged stool of Obamacare. The reason we call it that is because it only works if
it is balanced. Remove anyone of the legs and the stool is going to fall over. Remove
any one of these three things from Obamacare and the law would just fall apart. So that's
how Obamacare works. It also happens to be pretty much how Massachusetts's health care
system works. And Switzerland's for that matter. And those systems are working pretty well.
I mean have you seen the healthy glow of those swiss people and bostonians?
But what will all of this mean to you? You, like John, may have heard some pretty nasty
scary things about Obamacare. But here are the facts. If you are 65 or older and you
have medicare, nothing will change for you. By which I mean you keep your medicare, nothing
changes. You need to sign up for nothing on October 1st.
If you have insurance from you Job, or from someone in your family, then it's very very
likely that nothing will change for you either. Most people in the United States get their
insurance this way, and you will continue to do so next year too. You also need to do
nothing, on October 1st.
If you get your insurance from medicaid, or from the veterans administration, or from
some other government source. Then nothing will change for you either. You'll still get
your insurance from the government and you too need to do nothing, on October 1st.
That leaves the group of people who really need to pay attention to what's coming up
on October 1st. And those are legal citizens who are uninsured right now, or thing they
might be uninsured next year. That's who Obamacare is really going to affect, and there are just
over 30 million of you. You should go to www.healthcare.gov. That's been set up to help you get insurance
that you are going to be required to have in 2014. The site will ask you a few simple
questions, and use that information to make some recommendations for you for insurance.
If you make less than 133% of the poverty line, you'll qualify for medicaid., which
is free. Some states unfortunately aren't participation in the medicaid expansion which
will be a problem for very poor people in those states., but that's still in flux. Everyone
else will go to the insurance exchanges. Where companies will offer plans at bronze, silver,
gold, and platinum levels. The more you're willing to pay, the more robust your coverage
will be. But it's your choice. If you make less that 400% of the poverty line, you'll
get a subsidy to help with the premiums. And the vast vast majority of people who are uninsured
in the united states are going to get those subsidies. And for many of them the bronze
level plans will be pretty affordable. And that's it! There are other bells and whistles
to Obamacare, and we'll be covering them in future episodes., but this is what you need
to know right now to get ready for 2014. So whether you like the idea of Obamacare or
you hate it., it's coming on October 1st. You owe it to yourself to at least take a
look and consider your options . Go to healthcare.gov and see how much insurance is going to cost
you. It's not going to be as scary as you've been told. Even if it's not as awesome as
getting health care from aliens.