ObamaCare A Qualified Success
We’re 90 days past Sebelius’s near catastrophic launch. In spite of amazing roadblocks, Republican resistance and sabotage, Republican governor’s further undermining a key element to serve the health needs of our poorest citizens, and what our President had the honesty to characterize as “self inflicted wounds”, We’ve got a success here.
So, far, very early into the process, with a public very slow to awaken to new healthcare opportunities, no thanks to Health and Human Services lame marketing, 6 million of our fellow citizens now have health insurance, most for the first time in their lives. 2 million through the exchanges, 4 million through Medicaid. Think about it. This is huge in a 90 day period.
This leaves an estimated 5 million Medicaid eligible still uncovered and not likely to have this benefit anytime soon , due to dumb and immoral strategy in Red Republican-governed states. Still a long way to go to achieve universal care. A Democratic sweep of state houses can solve that problem.
Michael Moore just published a stinging critique of ObamaCare. As a fellow single payer advocate, I agree with him but I think Jared Bernstein’s observation hits the nail on the head. Moore has the policy right, but right now, not the politics.
I am heartened by single payer developments around the country, such as in Vermont. As Michael Moore believes, the single payer movement can push upward from progressive states. It can’t happen fast enough to satisfy me. Moore is right. To cast our health care lot with one of the most predatory industries in America is a tragedy waiting to happen.
One of my health care guru’s, Maggie Mahar, reports the polls actually read that 50% of those polled like health care reform; 35% like the ACA as it is and 15% think it should be more liberal. 50% oppose ACA at this early stage.
According to Mahar and WP’s Ezra Klein, just 0..6 % of American’s under 65 are losing their insurance purchased on the individual market and will have to pay more than their inadequate catastrophic coverage because of the new benefits enriched exchange policies. A survey they report on shows that 45% of these people agreed their old policies were inadequate. Irresponsible media reports say there are millions and tens of millions in this category. The actual number of those eligible to secure alternative catastrophic policies is estimated at around 500,000 people. And over 70% of them will qualify for government subsidies, bringing their premiums way down. These subsidies average $5,548 annually.
According to Mahar, a health policy expert, …”29% of those who are losing their policies make too much to be eligible for subsidies, ” and were premium-raped by these catastrophic policies. 15-30% of them suffered the stigma of preexisting conditions. These insurers spend 30% of their premiums on marketing, advertising, executive salaries and bonuses and other overhead costs and were infamous for cancelling policies like a revolving door, jacking up premiums and denying payments to providers. Prior to ObamaCare, these jackals turned over 35 % of their their policy holders each year. You did not hear any of this from the media, did you? They were too damned lazy to do their homework to give you the truth.
Mahar estimates that the catastrophic policy holders have three choices:l. Go without insurance while they can. 2. Pay an average of $135 a month for coverage of 57% of their bills. 3. Buy from the exchange; a person in their 20’s who makes too much to qualify for a subsidy can by an average bronze plan for about $185 per month. You do the math. Which would you do in their shoes. Of course, most will spend the extra $50 a month (remember, they make $45,000/year +) to get a real policy. This is why the industry is reporting the private catastrophic policies are not selling. The market the Republican’s like to worship is working in this case. Clearly, the consumer demand for ObamaCare is there and moving with great momentum. Soon we will have to move onto other issues including needed provider staffing levels and the out of control though improving cost escalation among health care providers. This blog will soon address these issues.
ObamaCare, a qualified success, is here to stay America. Get used to it.
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A lot of the newly covered people are in for a big surprise when they learn what a “deductible” is. All the Marketplace plans have very high deductibles, even the mid-level plans They are essentially catastrophic plans. There will be another political shock when people realize they have to pay premiums and also pay for the services. With a $3000 to $6000 deductible, most people will never have a bill paid by the insurance company and will pay cash for all their medical care. They will still have to choose between rent and medical care. It makes sense to keep going to the emergency room for all your services.
If you are used to a corporate employer plan with their normally low deductibles, you will be shocked to see the high deductibles allowed under the marketplace plans.
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The January 1st obama care hangover has started, and won’t be gone until obama is gone. This will be the longest new years hangover in history.
National Federation of Independent Business reports of their 11,000 business owners in New York State, Zero of them have reported that their health care insurance cost are going down. Actually, “an over whelming majority” with small firms that have less than 50 employees say their premiums have shot up.
Consumer spending accounts for 70% of the gdp. That slamming noise you hear is the sound of consumers wallets closing as they start cutting back to try and find a way to pay for the unaffordable health care act. Not going to be good for the economy, or families, or individuals, or anybody, except the small percentage of people who refuse to be responsible for themselves, so the whole country has to suffer for them.
Rusty, the business owners are not yet required to purchase plans, so there is an insurance industry-based explanation for the New York State small business plans, not an Obama based explanation.
Puck, as for deductibles, the smallest State offers (with really only two companies offering plans this year) a Gold level plan with a $1,000 deductible (my spouse’s choice) with a $3,000 oop cap. Had she opted for the Platinum plan with not too bad a premium at our income level, it would be next to nothing. It varies by state, but I’ll bet that’s close to your beloved corporate plans. California, the biggest state, has comparable deductible bargains because of their huge buying power.
Go to HealthPocket.com for more details on deductibles across the country.
Employer based insurance deductibles are going up and — like the increased cost-sharing for premiums — is the trend for making employees shoulder a greater burden of health care costs.
High deductibles are nothing new. As a self-employed person, I’ve been paying over $3,000/year for a BCBS (now Highmark) plan with a 10K deductible. Ten thousand dollars. And that plan is grandfathered in to the ACA because it hasn’t changed substantially in the past three years (aside from the cost of premiums going up, of course). At least it covers annual doctor visits and basic lab tests, plus other provider costs are less than they would be without any insurance at all.
The ACA subsidy program is really a godsend to the low- and middle-income self-employed, especially middle-aged people, who by sheer dint of living into their 50s are likely to have preexisting conditions. Medicaid expansion is essential, though, or those under the poverty cut-off are left out. I feel bad for people who live in states that didn’t expand Medicaid eligibility. I think the federal gov’t should run Medicaid as well as Medicare and require states to either contribute or show that they can run it themselves more efficiently. Wait — isn’t that the way it was supposed to be?
So, now I am better off with my Obama Care Insurance plan. True, the monthly premiums for my family are lower. (About $18,000/year vs $21,000/year). Not quite sure which doctors & hospitals are “in network”. Getting an official answer seems to be impossible-have to wait until I’m sick to find out. I’ll probably get sick while traveling & brought to an out of network hospital-get stuck with a $100K bill & then loose my home. My “brand” prescriptions are no longer covered because the government says the generic ones that don’t work really do work. This will cost me about $600/month-so much for the savings. The web site says that I didn’t pay my January premium, customer service is clueless-I am now carrying the canceled check in my wallet along with the insurance card. I would love to switch to a different carrier but the law says that I’m stuck with the 2 on the exchange-so much for living in a free country. I’d love to hire another part time employee-but with a $20K + yearly health insurance liability, I can’t afford it. My insurance agent told me to start putting money away for next year-probably see a $4K premium increase because not many young , healthy types can afford insurance. Obama Care is great. Maybe the president will tell me another lie to make me feel better.
Don’t worry. With that story, you’ll be raking in the wingnut welfare in no time.
Exactly, Jason. And radef16’s story smells fishy. His “brand” prescriptions are no longer covered? Welcome to the real world. That happens all the time. It has nothing to do with the ACA. And if he’s really a small business owner he should know that until the ACA he was one employee illness away from everyone in his business losing their health insurance.
Our household has insurance through a major company (you know, one of those corporate packages that everyone praises as the ideal) and it’s really good, but… what’s covered is constantly changing – and usually not to our benefit.
Our “brand” prescriptions have changed many times. Our deductible keeps increasing. Monthly premiums keep increasing. Honestly, do people really believe that the world of corporate insurance is free? That you control your prescriptions? That your deductible is low – that it doesn’t increase? That premiums don’t increase? It sure sounds like it.
I’ve written, in great detail, about this. Feel free to read.
Nonetheless, people who can’t afford do pay into employer health insurance will also find the markeplace plans unaffordable. The point was that there will be a renewed political backlash when people start getting medical bills on top of their new monthly insurance premiums. If people are still paying fees for service, the premiums are just helping to fill the wine rack on some rich guy’s yacht – as are the Federal subsidies that pad those premiums. Health care is still a ferocious funnel for trasferring wealth upward. We need to march toward single payer as soon as possible.
I’m all for single-payer.
As far as, “The point was that there will be a renewed political backlash when people start getting medical bills on top of their new monthly insurance premiums.” Who doesn’t get a bill on top of their premiums? If people are shocked by this then they either have never had health insurance or don’t handle the bills in their house.
I’m not holding my breath. For single payer to happen, we’ll need a President and/or Congress that doesn’t view “helping to fill the wine rack on some rich guy’s yacht” as the primary function of government.
It isn’t science fiction. There is no mystery. Successful, working single payer models exist. The problem is that they do not hold the profits of private insurance companies as sacrosanct.
“Who doesn’t get a bill on top of their premiums? ”
1. People with low deductibles who meet them early in the year.
2. People with high incomes for whom routine medical bills are an annoyance rather than a family crisis.
“For single payer to happen, we’ll need a President and/or Congress that doesn’t view “helping to fill the wine rack on some rich guy’s yacht” as the primary function of government. ”
I think politically we NEED the crisis that will result when people realize their priemiums aren’t buying them real coverage. The difference between “health insurance” and “health care” will become uncomfortably obvious, and Obamacare never dealt with it (out of deference to the insurance companies).
A “qualified success”? Are you kidding me? Just because you have “coverage”, doesn’t mean it’s what we need. Better get used to a bunch of mid-level providers, Walmart care, and Wawa health stations.
HMOs on steroids–and you know how well they were liked. Great idea, lousy reality.
I think we need people to comprehend that health insurance is not health care and vice versa. This has never been about health care. It’s about how families afford it and pay for it. Engaging in marginal fights over contraceptives when children can’t get treated for serious illness was and is silly and is a no win situation, especially when the public equates contraception with drug store rubbers and the implied purpose of the same. But let’s leave no stone unturned in the Sherman Williams approach (paint covering the world). By God, we are going get everything under the ACA umbrella, even if it affects the core purpose. Outstanding strategic planning and execution!
Leave it to a man to dismiss contraceptives as a marginal fight. Why not toss in maternity benefits, as well? Who cares if 50% of the population relies on these things – actually, 100% of the population relies on them, but only 50% bear the cost.
The core purpose of health insurance is to create a large enough pool to cover everyone’s needs. Next, someone will propose an insurance rider for genetic diseases. I mean, come on, why should I pay for that?
Well, sue me for thinking children’s access to both preventative and treatment procedures are of more concern than contraceptives. I’m not going to apologize for that. In fact I won’t even say leave it to a woman to equate contraception and prenatal care for both the fetus and the mother because that would sexist.
And why can’t we have contraception and prenatal care? You’re the one ranking health insurance participants. And I’d love to see were senior citizens rank on your “more concern” list.
It’s about how families afford it and pay for it.
This is not quite right. It *is* about access to health care — which in this country still means access to a method to pay for it. The ACA coverages provide a pretty broad set of services covered — in part to promote overall wellness care which ought to bring down the larger costs of care here. Because the folks who can’t pay for services either go without or have their fellow citizens pay the freight.
It is about access to health care – and also about defining what health care is, in terms of what insurance must cover.
Insurance is meaningless if it doesn’t cover primary care needs of everyone covered. Those who want to exempt reproductive or pre-natal care pretty much want the system to capture the funds of half of the paying population with serious health care needs in order to fund the rest. Insurance isn’t supposed to work this way.
BINGO cassandra! All vaccinations, contraception, eyeglasses and a nursing home bed should be free. Everything else, we can have the insurance discussion.
I mean really…we have people w/ too few eyelashes in this country, who can get a prescription and feel indignant insurance won’t cover it? First world problems.
“And why can’t we have contraception and prenatal care?’
Why can’t we have world peace, proper nutrition for children, great schools, while saving all the polar bears? Because sometimes we simply can’t have everything all at once. Sometimes change come slowly. Sometimes political expediency requires incremental approaches. I guess it’s because we are human beings and naturally imperfect. Usually because when you try to become all things to all people, you wind up being nothing to everyone. I’m not questioning the value or the need for contraceptive coverage, but it requires perspective. Priorities are necessary and appropriate. You want to fall on your sword over contraceptives? Fine. But I’ll not do it.
As far as seniors go, their health needs are important as they are for all humans, but again, if I have to prioritize, I’d prioritize the children higher. That’s my perspective. Yours may be different.
You know, you started with a false choice. You’re acting like we have to choose between contraceptives and children (LOL, that is a choice in the heat of the moment!) – that one of those has to go. Neither has to go.
The only reason you brought up contraceptives is because the GOP has made it an issue – they’ve bombarded a media that loves chasing shiny objects. Insurance companies are more than fine with providing contraceptive coverage because it’s far cheaper than pregnancy.
Please notice how Republicans/Conservatives focus on birth control and maternity care when they complain about the ACA. That isn’t an accident. They know if they say it enough it will worm its way into the general conversation. Notice how they aren’t talking about blood pressure medicine, COPD drugs, depression, restless leg syndrome, etc.. Hmmm… what do birth control and maternity benefits have in common?
Seriously, you are rating people in a way that sounds like those mythical death panels… or Logan’s Run. 😉
“You know, you started with a false choice. You’re acting like we have to choose between contraceptives and children ”
I disagree that it’s a false choice. The simple fact is there has to be priorities. However, I would be willing substitute other choices if it pleases you. But prioritization is a necessity and must happen. The organ donor program is an example of prioritization. Not enough organs to go around, so who gets them? Many people would use labels like rationing because it sounds distasteful, but we (the nation) certainly ration organs using transplant panels (death panels?).
I used contraceptives because there are organizations who do not wish to cover contraception. That was the only reason. Believe me as someone who deplores unwanted pregnancy, I am greater supporter of contraception that you can possibly imagine. I would had it out like candy, put free bins in the schools, stand on street corners and pass them out (if I wouldn’t be arrested that is). Still doesn’t change the fact that effective change is incremental and that can’t always get everything you want.
I understand incremental change, but that’s not what’s going on here. What’s going on here is a Republican talking point which only includes complaining about contraceptives and maternity coverage. Again, the reasons these two things are at issue is no accident.
The ACA is law so let’s not pretend that we need to get rid of things (or prioritize) to make the ACA a reality. That is why your claim is a false choice. You seem to be implying that in order to implement the ACA we need to bargain away contraceptive coverage. This is simply not the case. As far as contraceptive coverage… the controversy surrounds “religious” institutions.
The issue is neither contraceptive coverage nor any other specific part of the ACA. It is the lack of the ability to choose what coverage you or your organization wants. If you are morally opposed to contraceptives, blood transfusions (Jehovah’s Witnesses & others) or whatever other medical procedure, why should you be forced to pay for them? As I have said in the past, this USED to be a free country.
The foundation of liberalism is liberty, equality & a free market economy. How Obama Care or the President himself can be classified as “liberal” eludes me. Progressivism strives to be on the side of the working class. Please explain how the forced purchase of health insurance, shrinking provider networks & forever increasing bureaucracy benefit anyone, let alone the middle class.
Here are a few ideas that would be genuinely liberal:
-Work to reduce the actual cost of health care through meaningful tort reform (opposed by wealthy elitist lawyers), technology (such as telemedicine) and other progressive measures.
-Allow for the purchase of health insurance across state lines in an open & free market.
-Allow buyers to purchase only the coverage that they want or need.
-Disconnect health insurance from employment. Being forced to accept only the plan that an employer chooses certainly is not Progressive.
-Assist in the formation of true non-profit health insurance co-ops. This was the original concept behind Blue Cross & Blue Shield.
Finally, if a private company can provide cost effective, quality health insurance and good customer service, what is wrong with them making a profit doing so?
Calling Obama care a qualified success, is like saying we had a good night last night, because the wolf man broke into my house, but he only ate half of my family.
And here is the further absurdity of trying to deny ACA covered citizens contraceptive coverage for religious institution employees. If contraception, used by and morally acceptable to a huge majority of Catholics is wrong, where are vasectomies in the debate? Or tubal ligations ? Or hospital inserted IUD’s? For that matter, D&C’s performed by Catholic hospitals, which can have a pregnancy avoidance implication?
In the reverse, Catholic hospitals serve pork and non-Kosher on their inpatient/employee menus to observant Jews and Muslims though they are told they can order alternatives in the cafeteria or room menu. Vegetarian Hindu’s are subjected to meat on menus in Catholic hospitals. Jahovah’s Witnesses do not believe in blood transfusions, covered by the insurance plans they buy and used by hospitals they are admitted to. The hypocrisy and absurdity is endless.
Progressive Populist, take off your rose colored glasses, and start looking at links like these to see what is really happening regarding Obama Care
http://www.youtube.com/watch?v=Xxz7foLoLrU
Rusty, this is your idea of documentation? Seriously? Get lost.
Someone mentioned Tort Reform. Our cretin Republicans instituted this in Texas about 7 years ago. Result ? Absolutely no reduction in healthcare costs as its advocates predicted and in fact, Texas has some of the highest healthcare inflation in the country.
Anyone. Show me a Tort Reform success.
re: Tort Reform
To be successful, tort reform must be coupled with liability insurance reform.
Liability insurance adds a significant cost at each stage from raw materials to finished product. Any company involved with something “medical” pays a super premium for liability insurance. This applies to anything & everything medical no matter how mundane. It is highly likely that medical equipment & supply costs can be lowered by at least 10% simply by equalizing what those companies pay for insurance with that on non-medical items.
NO, IT HASN’T BEEN DONE BEFORE.
“Tort reform” has come to mean less rights and a deeper screwing for the little guy. No thanks. The only people who support it are elitist physicians and filthy rich health care executives.And FOX news viewers who are duped into supporting it.
Oh, so now you Republican clowns are changing the paradigm again to the detriment of consumers by claiming Tort Reform, to be successful, must be coupled with product liability insurance? You claimed you’d reduce healthcare costs via Tort Reform with caps on damages by crappy doctors; Texas capped at $250,000. The insurance industry reduced malpractice rates for doctors by 27%. Result? Nada. Nothing. No costs other than malpractice rates went down….insurance premiums skyrocketed, provider/hospital charges continued their climb there into the stratosphere. Correcting myself, the reform went into effect 10 years ago, thus a very good test market for your failed strategy to screw the consumer.
I’m not suggesting caps on damages, that is too simplistic. A reform of when & why people can sue, for example, based on a blind review by unrelated professionals along with a rework of the entire liability insurance system coupled with an agreement that savings would be passed on to consumers.
However, we need creative, progressive thinking to do it.
Currently a “Medical Grade” outlet strip costs in excess of $150.00. A very large percentage of this cost is due to the insurance burden put on its manufacturer and all of the upstream parts makers. It doesn’t need to be this way.
Medical Grade Outlet Strip costing $60.00.
Which means that the rest of your BS is, you know, BS, right?
Savings from decreased malpractice and liability insurance for doctors have not been passed on to patients in places like Texas where there is so-called Tort Reform. If there is additional liability for manufacturers of medical products, reducing or eliminating that certainly won’t be passed on to patients. The entire liability and tort cost of the entire health care industry is something like 2% of the total cost. Not much and certainly won’t bend the cost curve much.
A very large burden of the cost of a medical grade outlet strip is: 1) in the UL standards it has to comply with (UL 1363A) and 2) the market for these is more limited than the strips you use in your home.
Not BS, your just a better shopper than I am.
http://www.globalindustrial.com/p/tools/power-strips/surge-protectors/leviton-5300-h15-15a-surge-strip-6-outlet-hosp-grade-components-15-ft-cord?infoParam.campaignId=T9A&gclid=CJ6NnbDA6LsCFSbNOgod3kYAlw
http://www.4mdmedical.com/outlet-strip-hospital-grade-6-outlets-15-ft-cord-classic-preferred-cart.html#.UsoWRPT4J9U
None-the-less, a percentage of the cost is due to product liability insurance. Part of this being a successful approach would be to make sure that the savings are passed on to the patient.
At this point even a 2% reduction in medical costs is very significant. I bet that if enough smart people put their heads together numerous 2% cuts could be made without endangering the patient.
Tort reform is overplayed. In actuality it only speaks to 5% of the health industry tab, but of course gets big press when there is a ridiculous settlement. What’s the big dollar? Before “life” care and end-of-life care. Anyone in their golden years who has hit that point in their life, where you are not going to get better, but only sicker and more complicated has bought into the “bill of goods” that GNP dollars estimate 80% of your healthcare dollars are spent in the last 30 days of your life, with all the heroics, Hail Mary’s, and last ditch efforts. Some absolutely want that. Some say “no way”, but the majority have no clue, all they bought was time in a bed, miserable, sick, and taken piece by piece w/ loved ones exhausted and stressed by the care. Their reality never clicked that they would never go home again and work in their garden, or their woodshop, or play cards with the guys, let alone do puzzles with the grandchildren. It’s a horrible resource depletion, that people need to have a more honest conversation about. Personally, I know someone who received a THIRD kidney transplant in their 80s. To be quite frank, actuarial tables should have been used to decide what HIS COST should have been of normal life expectancy without mitigating circumstances, and see then the REAL VALUE of that kidney for someone on a long list. Is that fair?
“A reform of when & why people can sue, for example, based on a blind review by unrelated professionals along with a rework of the entire liability insurance system coupled with an agreement that savings would be passed on to consumers.
However, we need creative, progressive thinking to do it. ”
That’s basically an arbitration system owned by the insurance industry. There is however an existing system owned by a neutral party – the courts. The medical profession is just pissed that the little guy has access to the courts, and they want to put a stop to that.
a percentage of the cost is due to product liability insurance
A percentage of the cost of almost everything is due to liability insurance, so that is a pretty banal point. 2% isn’t much — and that includes insurance, lawsuits and payouts. There’s bigger pockets of savings to be had (see Joanne’s post) without letting doctors and equipment manufacturers be utterly unaccountable for quality of service.
My ultimate point is that there is too little being done to reduce the actual cost of health care. IMO, these options should have been explored prior to creating a new massive bureaucracy.
It is very obvious from this discussion that there may be multiple avenues available that each can shave a few points off of the final cost of services.
No one seems to object to my other suggested actions (relisted below).
Why isn’t everyone pushing their legislators to move on these?
-Allow for the purchase of health insurance across state lines in an open & free market.
-Allow buyers to purchase only the coverage that they want or need.
-Disconnect health insurance from employment. Being forced to accept only the plan that an employer chooses certainly is not Progressive.
-Assist in the formation of true non-profit health insurance co-ops. This was the original concept behind Blue Cross & Blue Shield.
Having only 2 available providers, both with mediocre plans, is unacceptable.
How about the following additions to the ACA:
“If, in a specific state, there are not greater than 6 independent providers of coverage plans, the citizens of that state shall be permitted to purchase plans from adjacent states. If the number of plans available in adjacent states is still insufficient, the plans offered in the next adjacent states shall be available.”
and
“Plans shall cover a minimum of 90% of all reasonable & customary fees regardless of the location or network affiliation of the provider.”
and
“Coverage for prescriptions shall be extended to Branded pharmaceuticals when deemed medically necessary by the patient’s physician.”
I bet that the insurance companies would go ballistic over these. Prime indication that they would be beneficial to consumers.
Let’s all work together to get the crap out of the ACA & make it The Truly Affordable and Quality Care Act (TAQCA).
You’re wrong about cost control: ACA has built in reimbursement based on results/outcomes with criterion being developed with physicians/hospitals/rehabs.
Medicare provider reimbursement has been and is very much being tightened. Hospitals are the gorilla in the room with about 30% of the reimbursement and I’ll be writing about that soon.
Across state lines? Insurance is regulated by states, including providers, premiums, rates, oversight (very weak right now as it is thanks to Republicans).
Buy what you need? We already have a choice of plans. Do you buy fire OR police protection based on your preference? Come on, cherry picking insurance covered items is very inefficient and does sabotage the spreading of risk, the very concept of insurance for hundreds of years.
You do not have to use your employers plan if you choose to opt out and buy on the open market but this usually is self defeating, because big employers have huge leverage in negotiating plan costs.
There are many non-profit insurance providers/HMO’s already and they, under ACA Exchange rules, have a reasonable profit limit. So, like most of the stuff above, you’re talking about changes already made, mostly by Obama/Pelosi.
90% coverage? That called the Platinum plan in ACA. Done already.
Re: generics vs. branded; truth is, most generics are mfg. by brand companies; same product, no marketing costs applied, thus cheaper. Pharma should be bid to ACA/feds just like VA meds. Then you’ll see quantum decreases. Clearly, you’ve not done your homework as most of your creative energy is reinventing a wheel already on the ground.
FYI, the Platinum plan has ZERO out of network coverage.
My homeowners insurance does offer coverage for specific risks and the ability to choose different deductibles for each risk category. For example, my deductible for catastrophic looses such as hurricane or tornado damage is very high in order to keep my premium low. I choose to take the $20,000 risk in the event of the total loss of my home. Why can’t similar choices be applied to health insurance?