Dr. Crippen, I am reading your blog post about the ACA right now, I have one month to decide, as I am now 26, to purchase private insurance though (current employers insurance).  The deductibles are insanely high, as well as the premiums…or wait for the January ACA kick in?

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What we have now is a situation where the cost of health care is escalating out of control with no end in sight, fueled by providers (yes doctors) that can create demand for their services and then supply it. As this process progresses, the affordability of health care insurance decreases commensurately. So insurers must cut more services to remain viable and employers must pass on the cost to you. Many employers will eventually stop providing health care services for employees. There is simply no way *private* insurance can be maintained. It will crash. Not a matter of if, but of when.

The issue of “junk” health care plans that were promised would remain viable after the onset of the ACA don’t directly apply to you. The law says that “junk” policies that allow you to pay a very small premium and fail to cover needed and necessary medical conditions is just what it is. You’re either insured or you’re not.

The law says policies must cover all potential illnesses but there can be varying amounts of co-pays and deductibles to keep the price down. In he ACA, if your illness lands in an area that is not covered at all in a junk policy, that area is at least covered to some degree, even as a catastrophic. This is a better deal than a junk policy.

So here’s my current opinion:

1. You do NOT want to go bare for any length of time. Yes, you’re young and healthy and you don’t think much about getting sick or injured, but an unexpected hospitalization, especially if it involves surgery or ICU care is so mind-alteringly expensive you have no conception of it. You would never be able to pay it off in three lifetimes, and you can be sure the hospital would be there to dun you for it for the entirety of those lifetimes.

2.  Expect to pay out of pocket for most of your health issues now and in the future. It’s just the reality. The issue of being *completely* indemnified for health care is vanishing. No insurance will be willing to pay for *all* of it, or even most of it. You will pay more every year and get less.

Ultimately, insurance will only cover what amounts to “catastrophic coverage”.  You will pay out of pocket for everything except disasters for which you are hospitalized.  Those out of pocket expenses will then seek out incredibly expensive deductions and co-pays.

3.  Given that the above is true, then it becomes a matter of *shopping around* to get the best deal possible for what you have to put into it. I assume your options are either your current (medical center based plan) or the ACA.

a) Your current medical center based insurance plan is extremely large. The good thing about insuring with a large employer is that they are “too big to fail”. They will always be offering health insurance no matter what the economy does. So it’s unlikely they’ll arbitrarily drop you when they run out of money, but they can and will make you pay more every year. You’ll break before they will.

b) As much of a political football the ACA is, it’s still here and its still recruiting patients.  Attempts to kill it at every social and political level have failed, including a presidential candidate that promised to kill it if elected and an attempt to shut down the government. Now the question comes up, will Republicans and other Philistines be able to kill it (after you’ve paid) in the future?  I say probably not. Enough people have signed up to make it impossible to negate their service, and more are signing up every day.

So, what the ACA seems to do is let you shop for a policy you can afford, and that’s a good thing for you, exactly what you need to do. Before, shopping around was time and labor intensive. Now because of the Internet, you have a unique opportunity to meticulously shop around and see what’s out there.

My humble personal opinion is also that the ACA is here to stay and will start to thrive once the word spreads and the website is 100% up to the task. I do not believe it is possible to kill it now.

The reality is simply that you will draw a metaphorical line graph. One line will describe the minimum and maximum you have to spend on a health care insurance policy and the other line will describe the cost and availability of such indemnification. Where those lines cross is the point where you will purchase a policy. It’s about as simple as that.

Bottom line:

* Don’t even dream of going bare.

* Expect to pay more for less

* Budget some mad money for unexpected out of pocket costs

* Get the most policy you can afford and hope for the best