I returned to HealthCare.gov the other to day to see how it's doing.
The good news: For New Jersey, the window shopping part of the site worked pretty well.
The bad news: If my family lost access to my employer-sponsored coverage, and we had to pay for individual coverage completely out of pocket, we'd have to come up with about $800 in extra cash per month just to buy skimpy, narrow-network, bronze-level coverage that would in no way compare with the coverage I have now.
We would probably not qualify for any subsidies. If my husband was still working, we would not qualify for a hardship exemption from the individual mandate based on the finding that the full list price of the coverage exceeded 8 percent of our household income. (And, really: Why would we want to go without major medical coverage, if we had any choice about that whatsoever?) We already live modestly (the Jersey City Goodwill store is my clothier of choice), and we would have to figure out how to live even more modestly.
But, think about this: I'm horrified by the idea of shelling out a little less than 8 percent of my household income for acute health care insurance -- and the country as a whole is spending about 17 percent of its income ("gross domestic product" means "national income") on acute health care costs.
In other words: Every funding source in the game is already spending a theoretical total of about $1,700 to $1,800 per month on my family's health care, even though the only health care we're using these days is checkups.
The Dutch have a terrific health care system, with no noticeable rationing or waiting, and they spend just 12 percent of GDP on health care. If the United States could cut the percentage of GDP going to acute health care to what the Dutch spend, and I had an extra $500 flowing into my bank account each month, I could buy great individual disability insurance, and a rich long-term care insurance (LTCI) policy, and still have some extra money left over.
If the United States could cut acute health care spending to 9.5 percent of GDP, my family could have great disability insurance, great LTCI coverage, and maybe a yacht. Maybe a big yacht.
So, on the one hand, Patient Protection and Affordable Care Act (PPACA) exchange implementation is a mess. The doctors hate the exchange plans provider network contract terms. The five doctors and hospitals that are actually in the exchange plans' narrow networks are all going to hold their breaths till they turn blue, die and come back to life as discount store greeters. Yadda yadda yadda.
But, eventually, whatever we do about PPACA and the exchange plans and all that stuff, we have to make people miserable and cut acute health care spending. We are just spending too much money on acute health care. That might make some people happy today, but it's one of the reasons consumers have a hard time imagining where they'd find the cash to do anything realistic about putting money aside for long-term care costs or other post-retirement expenses.