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Health Care Still Puts Too Much Burden on Family Budgets

Before the Affordable Care Act, we could lose health insurance just by getting sick. The Democratic Congress and President Obama got rid of that concern, but their Affordable Care Act still hasn’t made care affordable for a majority of Americans.

So say respondents to the Commonwealth Fund 2023 Health Care Afforability Survey:

Sara R. Collins, Shreya Roy, and Relebohile Masitha, Paying for It: How Health Care Costs and Medical Debt Are Making Americans Sicker and Poorer — Findings from the Commonwealth Fund 2023 Health Care Affordability Survey, Commonwealth Fund, October 2023.
Sara R. Collins, Shreya Roy, and Relebohile Masitha, Paying for It: How Health Care Costs and Medical Debt Are Making Americans Sicker and Poorer — Findings from the Commonwealth Fund 2023 Health Care Affordability Survey, Commonwealth Fund, October 2023.

57% of us are spending 10% or more of our income on health care:

Collins, Roy, and Masitha, Oct 2023.
Collins, Roy, and Masitha, Oct 2023.

This is the first such survey from the Commonwealth Fund, so they don’t offer pre-ACA data for comparison. But the United States continues to spend more than twice as much per capita on health care than the average health care expenditures of other advanced economies, pretty much all of which have far more robust systems of public health insurance. Among other things we need to do when we clear out the Republican chaoticians and theocrats from Congress in 2024 is revisit and reform the Affordable Care Act to provide more Americans better health coverage for less cost.


  1. Eve Fisher 2023-10-27 09:06

    The trouble is that in this country, when politicians talk about “health care”, what they mean is “health insurance”, and, since the health insurance lobby pays tremendous amounts of money to politicians, they are not going to do anything that would interfere with health insurance profits.
    Actual medical care should (1) never be for profit business and (2) never be run by bureaucrats whose primary job is to make a profit for their investors. We are stuck with the worst of both worlds.

  2. Richard Schriever 2023-10-27 09:15

    Hmmm. Spurred me to check. I have a combination of Medicare with a supplemental plan, private full coverage in a foreign country (Dr., hospital, dental, vision, and Rx) and employer paid coverage (disability, dental and vision) and it’s around 4%. That includes any deductibles and copays (don’t have any).

  3. O 2023-10-27 09:38

    We should also add in the hidden cost. Although work may provide the insurance coverage (or pay part of that premium), that is a cost to the employee. That is money that could have been salary. The employer is not paying it; the employee is.

  4. jerry 2023-10-27 10:04

    Work raises prices to offset the cost of health insurance and gets a tax deduction for doing so. You then tend to get and retain better and more stable employees. Also, that healthcare benefit is why a lot of folks work for the city, county, education and the state. They may have a sick child or spouse or even themselves. Kind of a double edge sword in many regards as their wages for working in the public sector might not be as high as in the private sector.

  5. sx123 2023-10-27 10:29

    We spend too much money on war for this to be on anyone’s radar.

  6. O 2023-10-27 10:33

    Jerry, if businesses get a tax break for providing insurance, isn’t the Fed already paying for insurance in effect? Let’s cut out the middleman and nationalize health insurance. Bigger pools mean lower rates.

  7. O 2023-10-27 10:45

    sx123, too much on wars both real and imagined!

  8. jerry 2023-10-27 13:48

    Group health insurance is different from Individual Health insurance, but they are both subsidized one way or another. Nationalized healthcare would solve all of these issues. In fact, if you look to Europe, you can see how it all works for the betterment of all. Healthcare in Europe is not only health insurance, it’s disability, workmen’s comp, paid maternity leave and retirement. European healthcare does not cover dental or eyewear. Most Europeans also enjoy a 30 vacation!! We could learn a lot by enjoying the freedom’s they have and especially, not worrying about going medically bankrupt.

  9. LCJ 2023-10-27 14:15

    But if you like your doctor you can keep your doctor!
    What a load of rubbish that was!

  10. cibvet 2023-10-27 14:20

    lcj– I kept my doctor, maybe yours just found a way to stop listening to your whining.

  11. jkl 2023-10-27 15:03

    if you are spending too large a percentage of your income on healthcare, then it is clear you should make more money!!!!! Yes, RELAX, this is just trolling on a Friday afternoon!!

  12. jerry 2023-10-27 15:12

    cibvet, that was good, really good man.

  13. Francis Schaffer 2023-10-27 16:43

    The government doesn’t pay for any business deductions or expenses; the people who actually pay taxes make up the short fall. I hear no one talking about the entitlements in the tax code which allows and encourages many to create generational wealth.

  14. LCJ 2023-10-27 19:56

    I still have my Dr since 2001 because I didn’t allow myself to be put in a position where I have to rely on or take advantage of a welfare option.
    But if you didn’t prepare yourself or were mentally impaired , then I will try not to judge you.
    Just kidding! You’re an imbecile.

  15. grudznick 2023-10-27 20:29

    Mr. jkl, that is a good plan more people should follow. If you have, like grudznick, Dr. Pepper, you should be prepared to make more money to pay his increasing charges, for Dr. Pepper is never satisfied.

  16. P. Aitch 2023-10-27 21:19

    Anyone who deducts the interest on a home loan is “taking advantage of a welfare option “. It’s “white welfare” and it was only initiated as an attempt to buy white votes.

  17. Algebra 2023-10-28 00:42

    While people in other countries spend their health care dollars staying alive, Americans spend their money trying to stay young and gorgeous. And that costs a lot of money, $16.7 billion was spent on cosmetic surgery. But the cost of obesity takes the prize: bariatric treatment cost $173 billion in 2019, before covid cancelled elective procedures. Bariatric surgery is now the way for surgeons to really make lots of money, even when, as it appears (from watching “My 600 Pound Life,”) it is seldom successful.

    Tell us again why the taxpayers should foot the bill for this..

  18. ABC 2023-10-28 00:57

    Thank you, Grudzniick! Brilliant idea!

    Holy Noem, she can get the sales tax collected on Dr. Pepper, say $2.00 plus 13 cents to her holy coffers, then, it’s easy!

    She consults with us wizards at Dakota Free Press (including grudznicki) and with the massive amounts of sales tax collected from people who drink pop, we can set up a social business all across the state, and here’s the genius thing we will do—-

    1. Buses to Winnipeg, leaving every hour, so people can get good medicine at Canadian lower prices! Buses for SD residents only. Free!

    2. Buses to Manitoba and Saskatchewan, higher wages paid there!

    3. Our Dr. Pepper consultancy can create great jobs and provide real answers for that age old South Dakota question—How can we pay higher wages and keep health care costs low! Can you imagine Bees having to pay for health care?

  19. ABC 2023-10-28 01:04

    Ad for Bees Health Care—

    Out of the Hive? Not covered?

    For $20, 000 a year , we will cover any 4 of your family!

    Best medical care for bees anywhere! High prices too! Canadian bees have to wait for months to get Hip replacement bee surgery!

  20. P. Aitch 2023-10-28 03:03

    Tell us again why the taxpayers should foot the bill for this asks Algebra. Taxpayers don’t “foot the biill”.
    – Elective surgery isn’t covered by insurance and is paid “out of pocket” by the elector.
    – Bariatric surgery has been nearly eliminated by the new weight loss medicines Ozempic, Mounjaro, and Wegovy. These meds are expensive but also not covered by health insurance.

  21. jerry 2023-10-28 06:58

    All the republicans need do is to stop essential coverage, to stop guaranteed coverage and to stop any kind of control over big pharma, Once they do that, and they now have a 58 page report on it by Jonestown Johnson, you will then see insurance payments go down. The reason being is that the insurance company’s will no longer have to pay any claims or very few. So you have a sick spouse, too bad, they made the choice to be sick and it’s the baby Jesus’s choice now to heal or die. Got a sick child, the same. Premature child, flip a coin, tails they win heads you lose. Simple soulutions from the simple minds of republcans.

  22. Richard Schriever 2023-10-28 14:55

    LCJ – I kept my doctor when I was using ACA marketplace insurance and have while I switched to Medicare as well.

  23. P. Aitch 2023-10-28 17:53

    I lost everything I owned because I got really sick, and my yearly Blue Cross health insurance policy needed renewal. They made the decision to not renew.
    Then the ACA regulated against that decision.

  24. grudznick 2023-10-28 18:48

    Those insurance fellows have to turn a dime just like the rest of the world, Mr. P.h, and they do what they do, I guess.

    grudznick always thought you lost everything over bad cooking and business management, but it is good the A C A came to help. And grudznick is very glad you are better now.

  25. Algebra 2023-10-29 06:40

    P. Aitch, bariatric surgery is covered by insurance, especially Medicaid, as the people who need it are unable to work. ( I became aware of this when I first encountered somebody who got hers paid for it by Medicaid in 1985.) It’s not going away, just google “market share predictions for bariatric surgery” yourself.
    It’s phenomenally expensive AND has poor outcomes.
    Those costs and outcomes are included in the statistics used to show how Americans spend so much on medical care but have poorer outcomes, along with the costs of cosmetic surgery not covered by insurance.
    And the more times you are knocked out with propofol, for whatever reason, the greater your odds of never waking up, like Michael Jackson and Joan Rivers. Hence poorer outcomes.

  26. jerry 2023-10-29 07:15

    @Algebra, a clock is correct twice a day, but your expanation deserves further review.

    “In order for Medicaid to cover the cost of your surgery and the associated surgeon visits, you must meet the requirements below.

    Over the age of 13 for a female and 15 for a male.
    Body Mass Index must be over 35 with at least one comorbidity.
    Co-morbidities include sleep apnea, high blood pressure, high cholesterol, diabetes.
    If you are under 21, you must have a Body Mass Index (BMI) over 40 with at least one comorbidity.
    A letter from your primary care physician stating that weight loss surgery is medically necessary.
    Passes a psychological exam.
    Documentation showing that the patient tried to manage their comorbidities with standard treatment but they were not successful.
    The patient must complete and show documentation that he or she participated in a medically supervised weight loss program for 6 months and it happened within the last 12 months prior to surgery.
    The patient must understand they will be required to change their diet and lifestyle after surgery.
    Nutritional and psychological services must be available before and after surgery (usually from the physician’s office).

    Key word is “Medically Necessary” So just because you are obese, you just can’t walk in a demand to lose a few pounds so you can get into your clothes and hit the dating scene.

  27. jerry 2023-10-29 07:21

    Explanation of where you can get the procedure “he facility that you have surgery at must be accredited as a Bariatric Center for Excellence. These facilities have acheived a level of excellence in bariatric surgery.”

    Further explanation on a Center of Excellence “Surgical Review Corporation (SRC), in collaboration with the American Society for Metabolic and Bariatric Surgery (ASMBS), has created a program to help highlight providers who deliver excellent care. The ASMBS Bariatric Surgery Center of Excellence® (BSCOE) designation helps identify where patients like you can expect to receive safer and more effective surgical treatment. Our program is tough, comprehensive and increasingly recognized by leading government and private insurers when making coverage decisions. These aren’t general surgeons who “dabble” in bariatric surgery – instead, you’ll hear most BSCOE surgeons refer to their work as a vocational calling.”

    So not any Tom, Dick or jerry can do this procedure, it is a lifesaving, medically necessary last resort, in many cases.

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