Thread by @evandawson

Excuse this thread. Here's a central question regarding health care in the United States.

If your deductible is $6,000, do you actually have health insurance?

NPR reports that high deductibles cost lives. People don't go to the doctor, or go too late.

npr.org/sections/healt…

2) How many people have high-deductible plans, you ask?

CDC says that in 2016, 39% of Americans with private plans were on high deductibles.

By 2018, the number had risen to 43%.

We're on track to have half the insured country on high deductibles.

3) Yesterday on Connections, I sat down with the architect of the Affordable Care Act, Jonathan Gruber. I asked, "If your deductible is $6,000, do you actually have health insurance?"

I'm going to tweet Gruber's full response in this thread. It's important.

4) GRUBER: "Yes you do. Let's remember what the word insurance means. It means protection against financial risk. And what's financial risk? Spending too high a share of your income. For sick individuals, who hit it year after year, that is very high. But...

5) "...for many individuals, they can afford to deal with a one-time shock of $6,000. What they can't afford is having a heart attack and a $100,000 bill. And the problem with insurance before the Affordable Care Act is you could have plans that said...

6) "...'Don't worry, you're covered, but if it's more than $10,000, you're not covered anymore.' That's not insurance. That's the opposite of insurance. So yes, a plan with a $6,000 deductible is insurance, but not for someone who has low means. That's why...

7) "...under the Affordable Care Act, we say that if your income's lower, we're going to help offset those deductibles by getting more generous insurance."

I followed up by saying that yes, this is catastrophic insurance, but people are choosing not to go for many other issues.

GRUBER: "The number one rule about health care is there's never an easy right or wrong. It's all about tradeoffs. The tradeoff here is, if you make health care free for everyone, then no one will be deterred from going to the doctor, but it will cost, best estimates 20-25% more."

9) So that's where we are. Gruber isn't saying he's glad that a huge number of Americans now have high deductible plans. He's saying, it beats the risk of bankruptcy and life-crippling catastrophe. And maybe it does!

10) But the data is pretty clear that when people have high deductibles, they avoid getting care unless it's an emergency. Not sure that should satisfy us. Under the ACA, it's the current reality. /end

11) ADDENDUM! I talked with Gruber about other stuff, too. He agreed with @matthewstoller that economic concentration is a problem. But here's what he said about deconcentration and trust-busting...

12) "I think it's clear there's too much economic concentration... I think it's been a big problem. I'm hoping regulators start to look more seriously. I think it's hard to break up companies, to be honest...

13) "...Elizabeth Warren has talked up breaking up some of the big companies. That's pretty traumatic and hard. It's a dynamic economy. New, giant companies are going to emerge. I think the main thing is to be more careful going forward.

14) Gruber says he wants to see giant companies share more wealth. One of his ideas:

"When you set up a new tech hub, the government owns the land around the tech hub, and when the land gets more valuable, that goes into a fund, which gets paid as a dividend to all Americans."

15) But on breaking up giants, Gruber:

"How do you break up Google? What does that even mean? When we broke up AT&T, there were regional companies. A natural way to break it up. People talk about breaking up Google and Amazon - I'm not even sure what that means.

16) "I think we have to recognize that those behemoths are here. We need to try to set a better landscape for competition, but we also need to figure out a better way to get the returns on their growth." /end