Insurance Cost = Premiums + Deductibles + Copays

Obamacare Enrollment Drive

MIAMI, FL – FEBRUARY 05: Aymara Marchante (L) and Wiktor Garcia sit with Maria Elena Santa Coloma, an insurance advisor with UniVista Insurance company, as they sign up for the Affordable Care Act, also known as Obamacare, before the February 15th deadline on February 5, 2015 in Miami, Florida. Numbers released by the government show that the Miami-Fort Lauderdale-West Palm Beach metropolitan area has signed up 637,514 consumers so far since open enrollment began on Nov. 15, which is more than twice as many as the next large metropolitan area, Atlanta, Georgia. (Photo by Joe Raedle/Getty Images)

OPINION by Wayne Caswell, founder & senior editor, Modern Health Talk

This is an obvious opinion piece that I posted on Huffington Post in response to another opinion piece, It’s Not Just You — Those Health Insurance Deductibles Are Getting Scary.


The article was well written but misleading because it failed to acknowledge that Total Insurance Cost = Premiums + Deductibles + Copays. Instead, it focused almost exclusively on high deductibles.

The general shift in the insurance market has been toward policies with lower premiums but higher deductibles that give consumers “more skin in the game”, often with the same or lower end cost. It’s also a shift away from employer-provided, prepaid medical care and instead toward insurance against financial ruin from catastrophic injury or illness. Where consumers before had just 2-3 choices among group plans, the ACA has promoted competition among dozens of insurers in exchange marketplaces with apples-to-apples comparisons to make shopping easier.

Insurance competition has already helped to flatten the rising costs, and to further encourage consumers to shop around for the best care value, insurers are now providing comparison tools and new pressure on providers to make pricing more transparent up front.

Since the ACA now prevents them from cherry-picking the healthiest customers by (1) denying coverage if there are preexisting conditions or (2) dropping customers if care gets expensive, insurers are seeking new ways to maintain profitability. That includes helping customers stay healthy.

Wellness programs that first appeared in corporate self-insured group plans are being extended to all customers, because insurers know that “an ounce of prevention is worth a pound of cure,” and because keeping their customer base healthy is more profitable.

We as a nation should acknowledge the benefits of these reforms and, rather than repeal Obamacare, work to improve it, because there’s still a lot more work to be done. Besides just flattening the cost curve, we theoretically should be able to cut healthcare costs in half at least and save over $1.5 trillion/year while improving care quality, patient satisfaction, and overall health. That’s because our current spending rate of $3 trillion/year is twice what other countries pay, yet we still live sicker and die younger, according to the World Health Organization.

Since we could use that savings to quickly pay-down the national debt, what’s holding up progress toward that goal? It’s the corrupting influence of big money in politics from the medical industrial complex, which spends twice as much on lobbying as the military industrial complex to protect its immensely profitable fee-for-service, “sick care” business model.

Readers should know that any call to repeal “Obamacare” without a better plan to replace it is either just a political move against a black President or funded by an industry that enjoys its perverse profits.

For More Information

See Understanding Obamacare for a rich list of educational videos, infographics, articles, and websites from government and other sources.