Business Insight Our Healthcare System I do not like applying statistics to practical medicine. Every patient is different and, while we do follow standard care based on statistics, we must review medical history and plans for treatment every single time. However, statistics are very helpful in understanding how medicine works as a part of the healthcare system. So, let's bring some numbers and reflect on their meaning. Before Affordable Care Act, known as Obamacare, there were roughly 50 million Americans without health insurance. This translated to one in six of everyone in the United States. After ACA, the numbers went down to about half of that. According to statistics, in 2022, there were 26 million. of Americans who were uninsured. Where are they mostly located? The state with the highest uninsured population is Texas, followed by Georgia and North Carolina. It is a little ironic because Texas has the 2nd largest economy, only after California. Who are the uninsured? The largest age bracket is 18-24. This means young but already working adults are missing any protection from getting sick or injured. Among the ethnic groups, Hispanic population has the largest uninsured status of almost 20%, followed by African Americans at 10.9%. presented by Arlington Dermatology Why are they lacking medical insurance? Well, this gets tricky. The number one problem is the cost. Premiums are very high on any insurance plan. The more comprehensive. plan and the lower the deductible, the higher is the cost. For instance, Blue Cross Bluet Shield PPO plan for a 24-year-old person, with $1000 deductible cost about $400 per month. But the same plan for a 50-year-old is $1100. I am giving you examples from a group plan and not individually purchased insurance. The second reason for lacking medical insurance is a dramatic cutback in public programs. Especially in states like Texas, there are no options. And finally, erosion of employer-based insurance plans. This last reason is much more complex. In many situations and for years, employers provided medical insurance to all employees and their families. This changed in the 2000s as the coverage became more and more expensive to the employers. In order to receive a good premium option, employers must meet certain standards: total number of employees, percentage of those who will opt out, employees age, and similar. It is not unusual for employers to continue medical insurance but with limitations: cover monthly contribution, or offer plans with employees but not families, require high $10,000+ deductibles. In either case, many employees simply cannot afford to pay their cost. They are the poorest part of our society and choosing between insurance premium and food or rent is a big challenge. This is very sad. It makes you look outside of the American statistics. It turns out that our system of healthcare delivery is the very last one compared to the rest of the modern world. Norway, France and Australia are leaders in the most effective and the highest quality healthcare. This is all despite the fact that the US spends the highest per capita annually on healthcare. These numbers do not lie. We spend the most and deliver the least. Certainly, there are many people that would disagree. We have excellent hospitals and technology, better than anywhere else. True. But who can use it? What happens to those who pick between food and rent and medical insurance? Recently, I got a bill from the lab. The test I needed was priced at $248. My insurance has a contract with the lab so they applied the fee schedule and discounted it. I still had my deductible unmet, so I had to pay. You know how much: $13.50. This was the contractual amount. Now, if you do not have insurance, there is no contractual fee. You will get a bill for $248. How does it make sense? Michael Bukhalo, MD Arlington Dermatology 5301 Keystone Court Rolling Meadows, IL 60008 Tel. 847 392 5440 | www.arlingtondermatology.net Business Insight Our Healthcare System I do not like applying statistics to practical medicine . Every patient is different and , while we do follow standard care based on statistics , we must review medical history and plans for treatment every single time . However , statistics are very helpful in understanding how medicine works as a part of the healthcare system . So , let's bring some numbers and reflect on their meaning . Before Affordable Care Act , known as Obamacare , there were roughly 50 million Americans without health insurance . This translated to one in six of everyone in the United States . After ACA , the numbers went down to about half of that . According to statistics , in 2022 , there were 26 million . of Americans who were uninsured . Where are they mostly located ? The state with the highest uninsured population is Texas , followed by Georgia and North Carolina . It is a little ironic because Texas has the 2nd largest economy , only after California . Who are the uninsured ? The largest age bracket is 18-24 . This means young but already working adults are missing any protection from getting sick or injured . Among the ethnic groups , Hispanic population has the largest uninsured status of almost 20 % , followed by African Americans at 10.9 % . presented by Arlington Dermatology Why are they lacking medical insurance ? Well , this gets tricky . The number one problem is the cost . Premiums are very high on any insurance plan . The more comprehensive . plan and the lower the deductible , the higher is the cost . For instance , Blue Cross Bluet Shield PPO plan for a 24 - year - old person , with $ 1000 deductible cost about $ 400 per month . But the same plan for a 50 - year - old is $ 1100 . I am giving you examples from a group plan and not individually purchased insurance . The second reason for lacking medical insurance is a dramatic cutback in public programs . Especially in states like Texas , there are no options . And finally , erosion of employer - based insurance plans . This last reason is much more complex . In many situations and for years , employers provided medical insurance to all employees and their families . This changed in the 2000s as the coverage became more and more expensive to the employers . In order to receive a good premium option , employers must meet certain standards : total number of employees , percentage of those who will opt out , employees age , and similar . It is not unusual for employers to continue medical insurance but with limitations : cover monthly contribution , or offer plans with employees but not families , require high $ 10,000 + deductibles . In either case , many employees simply cannot afford to pay their cost . They are the poorest part of our society and choosing between insurance premium and food or rent is a big challenge . This is very sad . It makes you look outside of the American statistics . It turns out that our system of healthcare delivery is the very last one compared to the rest of the modern world . Norway , France and Australia are leaders in the most effective and the highest quality healthcare . This is all despite the fact that the US spends the highest per capita annually on healthcare . These numbers do not lie . We spend the most and deliver the least . Certainly , there are many people that would disagree . We have excellent hospitals and technology , better than anywhere else . True . But who can use it ? What happens to those who pick between food and rent and medical insurance ? Recently , I got a bill from the lab . The test I needed was priced at $ 248 . My insurance has a contract with the lab so they applied the fee schedule and discounted it . I still had my deductible unmet , so I had to pay . You know how much : $ 13.50 . This was the contractual amount . Now , if you do not have insurance , there is no contractual fee . You will get a bill for $ 248 . How does it make sense ? Michael Bukhalo , MD Arlington Dermatology 5301 Keystone Court Rolling Meadows , IL 60008 Tel . 847 392 5440 | www.arlingtondermatology.net