Seventy percent of Americans describe the current U.S. healthcare system as being “in a state of crisis” or having “major problems.” This is consistent with the 65% to 73% range for this figure in all but one poll since Gallup first asked the question in 1994.

In that one poll — conducted right after the 9/11 attacks in 2001 — just 49% of Americans said the U.S. healthcare system had major problems or was in crisis. This was because of Americans’ heightened concerns about terrorism after the attacks, which temporarily altered their views and behaviors on a variety of issues.

The latest data are from Gallup’s annual Healthcare poll, conducted Nov. 1-11.

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70% of Americans describe the U.S. healthcare system as being “in a state of crisis” or having “major problems.” https://t.co/LN6AJ6hGnm pic.twitter.com/nzM3oxa2eM

— GallupNews (@GallupNews) January 14, 2019

As Congress once again turns its focus toward health care reform, the S.C. Department of Insurance posted some sobering news about 2018 health insurance prices.

The agency confirmed on its website Thursday that average premiums for HealthCare.gov polices will skyrocket 31 percent in South Carolina next year, confirming information the federal government published on the future of health insurance costs earlier this summer.

Some customers will face higher increases than others. A 60-year-old patient in Charleston County who doesn’t use tobacco and wants to buy a “silver” plan next year will pay about 28 percent more. His monthly premium will increase from about $837 a month this year to $1,068 a month next year.

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As so often happens, a frantic mother called us about her 19-year-old daughter, who I’ll call Jen. A heroin addict, Jen had been shuttled between multiple treatment centers and sober homes by greedy marketers looking to cash in on the teenager’s insurance benefits by keeping her perpetually in recovery, but never sober. As our investigator searched Palm Beach County for Jen, her mother finally reached her by phone. She pleaded with her daughter to leave Florida, to which Jen replied, “Why would I come home? I have all I need here.” In the ensuing months, Jen has become a victim of a vicious cycle known as “the Florida shuffle.” She has continued in and out of treatment, repeatedly relapsed and overdosed, been on the brink of death, was revived and all the while trafficked by marketers offering free rent and other gifts — as she ignores her mother’s desperate pleas to come home.

Americans know of the carnage wrought by the opioid epidemic. According to the U.S. Centers for Disease Control, opioids caused 91 deaths every day in 2015. Expect a significant increase when the 2016 medical examiner and coroner reports are released nationwide. In my jurisdiction alone, 596 people died from opioid-related deaths in 2016, an increase of 286% since 2012.

Less known, however, is that this growing epidemic has been fueled in part by the manipulation of well-intended federal laws — such as the Affordable Care Act (ACA) and Mental Health Parity Act — by unscrupulous individuals looking to profit on the misery and vulnerability of others. Fueled by new financial benefits in federal law, private drug treatment providers have flourished, as marketers often push individuals with substance use disorder to the warm weather states of Florida, Arizona and California as recovery destinations. The unethical players within the recovery industry see the addict as a valuable commodity and have exploited federal law to foster a cycle of relapse, rather than recovery.

Today, big money in the drug treatment industry comes through failure. …

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The U.S. health-care system remains among the least-efficient in the world.

America was 50th out of 55 countries in 2014, according to a Bloomberg index that assesses life expectancy, health-care spending per capita and relative spending as a share of gross domestic product. Expenditures averaged $9,403 per person, about 17.1 percent of GDP, that year ”” the most recent for which data are available ”” and life expectancy was 78.9. Only Jordan, Colombia, Azerbaijan, Brazil and Russia ranked lower.

The U.S. has lagged near the bottom of the Bloomberg Health-Care Efficiency Index since it was created in 2012. Hong Kong and Singapore ”” consistently at the top ”” are smaller countries with less diverse populations. Their governments also play a stronger role in regulating and providing care, with spending per capita averaging $2,386 and longevity averaging about 83 years.

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Obamacare failed because it flunked Economics 101 and Human Nature 101. It straitjacketed insurers into providing overly expensive, soup-to-nuts policies. It wasn’t flexible enough so that people could buy as much coverage as they wanted and could afford ”” not what the government dictated. Many healthy people primarily want catastrophic coverage. Obamacare couldn’t lure them in, couldn’t persuade them to buy on the chance they’d get sick.

Obamacare failed because the penalties for going uncovered are too low when stacked against its skyrocketing premium costs. Next year, the penalty for staying uninsured is $695 per adult, or perhaps 2.5 percent of a family’s taxable household income. That’s far less than many Americans would pay for coverage. Financial incentive: Skip Obamacare….

Obamacare failed because it hasn’t tamed U.S. medical costs. Health care is about supply and demand: People who get coverage use it, especially if the law mandates free preventive care. Iron law of economics: Nothing is free; someone pays. To pretend otherwise was folly. Those forces combined to spike the costs of care, and thus insurance costs.

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Banning resident Jim Bailey and his wife went in recently for their annual physicals. They came away with hundreds of dollars in charges for co-pays and tests.

Bailey, 78, told me that he feels duped.

“The Affordable Care Act dictates that all annual physicals be provided at no cost to the policyholders ”” no deductibles or co-pays,” he said. “But that wasn’t the case with us.”

Nor will it be the case with anyone else ”” even though many Americans believe otherwise.

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Premiums for health plans sold through the federal insurance exchange could jump substantially next year, perhaps more than at any point since the Affordable Care Act marketplaces began in 2013.

An early analysis by the Kaiser Family Foundation shows that proposed rates for benchmark silver plans ”” the plans in that popular tier of coverage that determine enrollees’ tax subsidies ”” are projected to go up an average of 10 percent across 14 major metropolitan areas.

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Danny and his wife Linda, who teaches fourth grade at a public school in Canton, Ga., got their health insurance through the state’s Blue Cross Blue Shield plan. Because Danny had torn his Achilles tendon earlier that summer playing basketball, the family had already blown through their $5,000 deductible. Linda’s doctor and their local hospital were both listed as in-network providers, so the Postells didn’t expect they’d have to pay any more out of pocket for Luke’s birth.

But then a stream of mysterious bills started rolling in. Why hadn’t anyone told them there’d be a $1,746 fee for an initial neonatal visit? What is the $240-per-day charge for Luke’s “supervision of care”? Wasn’t this all”“$4,279 in the end”“supposed to be covered by insurance?

Danny, who knew something about medical billing from his work as a pharmacist, quickly discovered the cause. While the local hospital was considered an in-network provider, the neonatal intensive-care unit at that same facility was not. Once Luke was whisked across that invisible line, wham: everything was out of network. “You’d think someone at some point would have told us that,” Danny says.

Read it all (my emphasis) and if necessary another link is there.

As part of his push for the Affordable Care Act in 2009, President Obama came to Central High School to laud this community as a model of better, cheaper health care. “You’re getting better results while wasting less money,” he told the crowd. His visit had come amid similar praise from television broadcasts, a documentary film and a much-read New Yorker article.

All of the attention stemmed from academic work showing that Grand Junction spent far less money on Medicare treatments ”“ with no apparent detriment to people’s health. The lesson seemed obvious: If the rest of the country became more like Grand Junction, this nation’s notoriously high medical costs would fall.

But a new study casts doubt on that simple message.

“Price has been ignored in public policy,” said Dr. Robert Berenson, a fellow at the Urban Institute, who was unconnected with the research. Dr. Berenson is a former vice chairman of the Medicare Payment Advisory Commision, which recommends policies to Congress. “That has been counterproductive.”

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“The deductible, $3,000 a year, makes it impossible to actually go to the doctor,” said David R. Reines, 60, of Jefferson Township, N.J., a former hardware salesman with chronic knee pain. “We have insurance, but can’t afford to use it.”

In many states, more than half the plans offered for sale through HealthCare.gov, the federal online marketplace, have a deductible of $3,000 or more, a New York Times review has found. Those deductibles are causing concern among Democrats ”” and some Republican detractors of the health law, who once pushed high-deductible health plans in the belief that consumers would be more cost-conscious if they had more of a financial stake or skin in the game.

“We could not afford the deductible,” said Kevin Fanning, 59, who lives in North Texas, near Wichita Falls. “Basically I was paying for insurance I could not afford to use.”

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….the controversial law still faces a bumpy future. Here are five challenges the ACA will face during the next several years:

Healthcare costs are still too high. As many enrollees are discovering, the “Affordable” Care Act is somewhat misnamed. Healthcare costs continue to rise faster than wages or overall inflation, putting a financial burden even on people who have healthcare. A recent study by the Commonwealth Fund found that 23% of Americans who have healthcare coverage are “underinsured,” meaning their out-of-pocket spending on healthcare is more than 10% of their income in a given year. Deductibles and other out-of-pocket costs have been rising because consumers and businesses have been opting for plans with lower premiums””which usually require the patient to bear more of the cost before 100% coverage kicks in. The irony is that insurance has gotten more affordable, but actual healthcare hasn’t.

The ACA includes several long-term provisions meant to explore ways to lower costs, but they may not be nearly enough to offset other trends pushing costs up, such as the retirement of the baby boomers and the development of expensive new drugs. If Congress ever gets serious about improving the ACA rather that faux-repealing it, cost will be the thing to focus on.

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A different health care issue has emerged for Democrats, in sync with the party’s pitch to workers and middle-class voters ahead of next year’s elections.

It’s not the uninsured, but rather the problem of high out-of-pocket costs for people already covered.

Democrats call it “underinsurance.”

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I will take comments on this submitted by email only to KSHarmon[at]mindspring[dot]com.

When Melissa Mira suffered sudden heart failure at the end of her second pregnancy last year, she worried first about her health and her baby ”” then about the more than $200,000 in medical bills that began rolling in.

“Your world is just crashing down around you and you wonder: ”˜How is this going to be covered?’”‰” recalled Mira, 30, who spent more than a month away from her Tacoma home, hospitalized at the University of Washington Medical Center.

For Mira and her family, the answer came not through traditional health insurance, but through faith that fellow Christians would step forward to pay the bills.

The Miras ”” including daughter Jael, 4, and baby Sienna Rain, now a healthy 9-month-old ”” are among the growing numbers of people looking to “health care-sharing ministries” across the U.S.

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Even worse for Democrats, the Saez paper found that “information about inequality also makes respondents trust government less,” decreasing “by nearly twenty percent the share of respondents who ”˜trust government’ most of the time:”

Hence, emphasizing the severity of a social or economic problem appears to undercut respondents’ willingness to trust the government to fix it ”” the existence of the problem could act as evidence of the government’s limited capacity to improve outcomes.

The findings of the Saez group are consistent with Luttig’s. Taken together, they suggest that even if Democrats win the presidency and the Senate in 2016, largely on the basis of favorable demographic trends, the party will confront serious hurdles if it attempts to deliver material support to working men and women and the very poor. Redistribution is in trouble, and that is likely to tie American politics in knots for many years to come.

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Last year, a study found that about four out of every 10 people who received financial help from the government while buying their Obamacare health plans had no idea they were getting any assistance.

This tax season, many of those people may be in for a rude surprise when they’re asked to pay some””or even all””of that money back….

“I wasn’t very happy,” said Mike Highsmith, 61, a retired US Airways flight attendant who learned after having his taxes done that he has to pay back every cent of the $6,624 in federal subsidies that helped pay the lion’s share of his HealthCare.gov-purchased plan.

“This shocked me … I didn’t know this was coming.”

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A recent survey by private health insurance exchange EHealth highlights the pressure Americans are feeling. It found that more than 6 in 10 people say they’re more worried about the financial effect of expensive medical emergencies and paying for healthcare than about funding retirement or covering their kids’ education.

People who get health insurance through work and on their own have seen their costs rise dramatically over the last decade.

According to the Commonwealth Fund, a New York think tank, annual increases in work-based health plan premiums rose three times faster than wages from 2003 to 2013. Out-of-pocket costs have also been climbing.

“More people have deductibles than ever before,” says Sara Collins, a Commonwealth Fund vice president. From 2003 to 2013, the size of deductibles has grown nearly 150%.

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The nation’s shortage of doctors will rise to between 46,000 and 90,000 by 2025 as the U.S. population grows, more Americans gain health insurance and new alternative primary care sites proliferate.

A new study announced by the Association of American Medical Colleges (AAMC), a lobby for medical schools and teaching hospitals, said “the doctor shortage is real” with total physician demand projected to grow by up to 17 percent as a population of baby boomers ages and the Affordable Care Act is implemented.

“It’s particularly serious for the kind of medical care that our aging population is going to need,” said Dr. Darrell Kirch, AAMC’s president in a statement accompanying the analysis by research firm IHS.

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Based on oral arguments this morning, the latest Supreme Court showdown over Obamacare could lead to another narrow ruling determining the fate of the health-care program. Here are five important takeaways from the hearing in King v. Burwell, a challenge an IRS rule providing financial assistance to millions purchasing health insurance through federal-run exchanges offered in states that did not create their own online marketplaces….

(1) The vote will be close. The four justices from the court’s liberal wing appear on board with the Obama administration’s argument that all exchanges — whether state or federal — can offer subsidies. Justice Anthony Kennedy and Chief Justice John Roberts are still potential swing votes. Justices Antonin Scalia and Samuel Alito seem to sympathize with the plaintiffs’ argument that the text of the Affordable Care Act only authorizes subsidies in state-run exchanges….

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The Supreme Court on Wednesday considers the most serious challenge to the Affordable Care Act since the justices upheld it as constitutional almost three years ago.

At issue is whether millions of Americans who receive tax subsidies to buy health insurance are doing so illegally. If the justices rule that the payments are not allowed, the entire health-care law could be in jeopardy.

The latest showdown between the Obama administration and the conservative legal strategists who have targeted the law since its passage in 2010 focuses on a once obscure phrase in the legislation: “established by the State.”

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Cathy Keaton’s health insurance premium will jump nearly $400 each month if the U.S. Supreme Court rules that she’s ineligible for a federal subsidy to lower the price she pays.

The 63-year-old part-time College of Charleston student said she couldn’t afford coverage without the substantial discount she receives.

“It’s very scary for me,” Keaton said. “If I lose this, it means that I will have to make some really hard decisions until I can get Medicare.”

She’s not alone. Insurance premiums for thousands of HealthCare.gov customers in South Carolina could increase by 400 percent if the U.S. Supreme Court rules that they’re ineligible for subsidies this summer.

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The self-proclaimed caliphate of Islamic State, also known as ISIS, is fighting across Syria and Iraq, pushing back larger armies and capturing entire cities. It is also waging an increasingly sophisticated media campaign: The militant group has recruited disillusioned youth as it tries to extend its reach across the Muslim world and beyond. How much do you know about the Islamic State? Test your knowledge.

Check it out and see how you do.

A decision made more than three years ago by a committee that no longer exists might deal a major blow to Obamacare in South Carolina this summer.

That’s when the U.S. Supreme Court will decide if customers who shop on HealthCare.gov can use federal financial aid to lower the amount they pay for insurance. Those customers include 37-year-old Erin Johnson and more than 140,000 other low- to middle-income South Carolinians who already receive those health insurance subsidies.

“If it’s full price, I honestly don’t think I could do it. I really don’t make much,” said Johnson, a medical courier from Goose Creek. She receives a federal discount worth more than $100 and pays only $56 a month for her policy. Before she purchased the plan in October, she was uninsured. “I needed it. It was pretty awesome.”

Read it all from the local paper.

Physician Praveen Arla is witnessing a reversal of health care fortunes: Poor, long-uninsured patients are getting Medicaid through Obamacare and finally coming to his office for care. But middle-class workers are increasingly staying away.

“It’s flip-flopped,” says Arla, who helps his father run a family practice in Hillview, Ky. Patients with job-based plans, he says, will say: ” ‘My deductible is so high. I’m trying to come to the doctor as little as possible. ”¦ What is the minimum I can get done?’ They’re really worried about cost.”

It’s a deep and common concern across the USA, where employer plans cover 60% of working-age Americans, or about 150 million people. Coverage long considered the gold standard of health insurance now often requires workers to pay so much out-of-pocket that many feel they must skip doctor visits, put off medical procedures, avoid filling prescriptions and ration pills ”” much as the uninsured have done.

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Santa Claus is going to be bringing lots of presents in a couple of weeks, but lower health-insurance costs for most Americans won’t be one of them.

People with insurance through an employer””that is, most people with health coverage””are paying “more in premiums and deductibles than ever before” as those costs outpace the growth of wages, a new report finds.

Total premiums for covering a family through an employer-based plan rose 73 percent from 2003 through 2013, while workers’ personal share of those premium costs leaped 93 percent during the same time frame, the Commonwealth Fund report said. At the same time, median family income grew just a measly 16 percent.

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Leading U.S. CEOs, angered by the Obama administration’s challenge to certain “workplace wellness” programs, are threatening to side with anti-Obamacare forces unless the government backs off, according to people familiar with the matter.

Major U.S. corporations have broadly supported President Barack Obama’s healthcare reform despite concerns over several of its elements, largely because it included provisions encouraging the wellness programs.

The programs aim to control healthcare costs by reducing smoking, obesity, hypertension and other risk factors that can lead to expensive illnesses. A bipartisan provision in the 2010 healthcare reform law allows employers to reward workers who participate and penalize those who don’t.

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The Supreme Court announced Friday that it will hear the most serious challenge to the Affordable Care Act since the justices found it constitutional more than two years ago: a lawsuit targeting the federal subsidies that help millions of Americans buy health insurance.

More than 4 million people receive the subsidies, which the Obama administration contends are essential to the act by making insurance more affordable for low- and middle-income families.

But challengers say the administration is violating the plain language of the law. They are represented by the same conservative legal strategists who fell one vote short of convincing the court that the law was unconstitutional the last time around.

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They have health insurance, but still no peace of mind. Overall, 1 in 4 privately insured adults say they doubt they could pay for a major unexpected illness or injury.

A new poll from The Associated Press-NORC Center for Public Affairs Research may help explain why President Barack Obama faces such strong headwinds in trying to persuade the public that his health care law is holding down costs.

The survey found the biggest financial worries among people with so-called high-deductible plans that require patients to pay a big chunk of their medical bills each year before insurance kicks in.

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The policies available on the Obamacare exchanges are hastening this trend. Many enrollees are opting for the bronze and silver plans, which often carry deductibles upwards of $5,000 and $2,000, respectively.

“The bronze plans are scaring a lot of administrators because the patient liability is so large,” said Debra Lowe, administrative director of revenue cycle at Ohio State University’s Wexner Medical Center. “Patients are unaware they have this high deductible.”

Upfront payments aren’t usually required, but more hospitals are asking patients to settle the bill in advance. If patients can’t afford the charges, some hospitals place them into financial assistance programs, such as payment plans or low-interest loans. Others help them sign up for Medicaid or individual coverage on the Obamacare exchanges. Patients can still opt to wait until after the bill goes through their insurance.

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Next year, even more corporate workers are likely to be offered high-deductible plans ”” sometimes known more benignly as consumer-directed plans ”” and at a rising share of large companies, it will be the only option remaining.

Just as employers replaced pensions with retirement savings plans, more large companies appear to be in a similar cost-sharing shift with health plans. Besides making workers responsible for more of their care, employers hope these plans will motivate employees to comparison-shop for medical services ”” an admirable goal but one that some say is hard to achieve.

Several big companies started offering consumer-driven plans as their only option in the last couple of years, including JPMorgan, Wells Fargo, General Electric and Honeywell, among others; it is the only choice for Bank of America employees earning more than $100,000.

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A rush of newly insured patients using health services has boosted hospital operators’ fortunes but has racked up costs that insurers didn’t anticipate, corporate filings and interviews with executives show.

People are getting more back surgeries, seeking maternity care and showing up at emergency rooms more frequently, executives say, boosting income for hospital operators.

At Tenet Healthcare Corp….patient volumes rose 4% in the second quarter compared with a year earlier, while uninsured inpatient admissions slid 22%….

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