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  • Hi I'm Dr Aaron Carroll. And in this new youtube show we are going to try and help you under stand how medical

  • research and health policy work. We are going to make sense of a lot of the confusing information

  • in the world, and we are going to have a lot of fun doing it.

  • We are officially launching in a few weeks, but today, we're going to give you a little

  • preview., and talk to you about Obamacare. So I have this friend that is a little bit

  • of a hypochondriac, his name is John Green., and he's been asking me a lot of panicked

  • questions about Obamacare.

  • John: Wait Aaron I heard the cost of my families insurance is going to triple in the next year?.

  • Aaron: No

  • John: Well my uncle told me his medicare is being taken away, thats true, right?

  • Aaron: That's not going to happen.

  • John: Alright Aaron, what about this? I heard that under Obamacare medications are now going

  • to have side effects.

  • Aaron: That was already the case.

  • John: I just got this email from a friend who said under Obamacare anyone over the age

  • of 45 will be euthanized.

  • Aaron: Wow, absolutely not. John: Also, that reminds me, I just got an

  • email about someone whose lupus was cured by Aliens. Why don't we just get our healthcare

  • from Aliens? Aaron: Well I suppose...wait NO thats not

  • how we get healthcare.

  • Okay, clearly we need to start with the basics. Let's talk about what Obamacare is, and what

  • it isn't. And what changes are in store for you.

  • Health Care triage Although Obamacare was passed in 2010, the

  • big pieces of the law are scheduled to go into effect on October 1st, just days from

  • now. But what does that mean to you? Will your insurance change? Will you still be able

  • to get medical care? If you don't have insurance right now, how will you get it? No matter

  • what you think of the law politically it in your best interest to get as much out of it

  • as you can. So today we are going to explain how Obamacare works, and how it will affect

  • you. (Over 47,000,000 Americans were uninsured

  • in 2012) For decades the most glaring problem in the

  • United States healthcare system has been that millions of people are uninsured. We are one

  • of the few industrialized countries in the world that doesn't provide universal coverage

  • to its citizens. Here is a list of some of them that do. For the past few years the number

  • of people that lack any coverage for a year has hovered around 50 million people. Is that

  • list still scrolling? We'll wait. By the way all of those countries are democracies, they

  • all voted to get that universal coverage.

  • Lots of people don't have insurance because they have some form of chronic illness. That's

  • not a surprise, because I mean come on, if you're already sick, what insurance company

  • would want to cover you? And if they do, the policy that they will give you will likely

  • cost a fortune. And that's a whole other problem, health insurance is really really expensive.

  • Last year the average employer sponsored health insurance policy cost almost $6000 for an

  • individual. The average plan for a family, cost more than $16,000. The average 2 bedroom

  • apartment rents for about $12,500. I'm just saying, thats too much money for many americans

  • to afford. The architects of Obamacare had a number of

  • very straightforward goals. The first was to make sure that no one could be denied insurance

  • if they wanted to buy it. This idea is called guaranteed issue. The second is that people

  • should all be charged a similar amount, even if they have a chronic condition. They shouldn't

  • be punished for being sick. This idea is called community ratings. That's not to be confused

  • with the TV show community's low ratings, which are infuriating cause that show is awesome.

  • These are the major thrusts of Obamacare's regulations, but there is a problem here.

  • If you make it so noone can be denied a plan if they want it, and no one can be forced

  • to pay more if they're sick; there's no reason for health people to buy insurance. They can

  • just wait until they get sick, and then they can go buy a plan for the same amount that

  • they could have before they got sick. But if only sick people buy insurance, then the

  • price of premiums go way up. This leads to even more health people to skip buying a plan,

  • only sick people are left, price goes up even more, more healthy people opt out, and we

  • get what we call a death spiral for the private insurance industry. Which while it sounds

  • really cool, we really don't want that to happen.

  • To avoid this, we need to come up with a way to convince healthy people to buy insurance.

  • One way it to charge people a penalty if they don't. Obamacare handles this by charging

  • people a fine of $95 or 1% of their income if they don't buy insurance. That's the individual

  • mandate, but that creates one more problem. Who do you make people pay for something if

  • they can't afford it? One way would be to subsidize it. And people who make less that

  • 400% of the poverty line, will get a tax credit from federal government to help them pay for

  • the insurance. These are the subsidies of Obamacare.

  • These three factors , the regulations, the individual mandate, and the subsidies from

  • the three-legged stool of Obamacare. The reason we call it that is because it only works if

  • it is balanced. Remove anyone of the legs and the stool is going to fall over. Remove

  • any one of these three things from Obamacare and the law would just fall apart. So that's

  • how Obamacare works. It also happens to be pretty much how Massachusetts's health care

  • system works. And Switzerland's for that matter. And those systems are working pretty well.

  • I mean have you seen the healthy glow of those swiss people and bostonians?

  • But what will all of this mean to you? You, like John, may have heard some pretty nasty

  • scary things about Obamacare. But here are the facts. If you are 65 or older and you

  • have medicare, nothing will change for you. By which I mean you keep your medicare, nothing

  • changes. You need to sign up for nothing on October 1st.

  • If you have insurance from you Job, or from someone in your family, then it's very very

  • likely that nothing will change for you either. Most people in the United States get their

  • insurance this way, and you will continue to do so next year too. You also need to do

  • nothing, on October 1st.

  • If you get your insurance from medicaid, or from the veterans administration, or from

  • some other government source. Then nothing will change for you either. You'll still get

  • your insurance from the government and you too need to do nothing, on October 1st.

  • That leaves the group of people who really need to pay attention to what's coming up

  • on October 1st. And those are legal citizens who are uninsured right now, or thing they

  • might be uninsured next year. That's who Obamacare is really going to affect, and there are just

  • over 30 million of you. You should go to www.healthcare.gov. That's been set up to help you get insurance

  • that you are going to be required to have in 2014. The site will ask you a few simple

  • questions, and use that information to make some recommendations for you for insurance.

  • If you make less than 133% of the poverty line, you'll qualify for medicaid., which

  • is free. Some states unfortunately aren't participation in the medicaid expansion which

  • will be a problem for very poor people in those states., but that's still in flux. Everyone

  • else will go to the insurance exchanges. Where companies will offer plans at bronze, silver,

  • gold, and platinum levels. The more you're willing to pay, the more robust your coverage

  • will be. But it's your choice. If you make less that 400% of the poverty line, you'll

  • get a subsidy to help with the premiums. And the vast vast majority of people who are uninsured

  • in the united states are going to get those subsidies. And for many of them the bronze

  • level plans will be pretty affordable. And that's it! There are other bells and whistles

  • to Obamacare, and we'll be covering them in future episodes., but this is what you need

  • to know right now to get ready for 2014. So whether you like the idea of Obamacare or

  • you hate it., it's coming on October 1st. You owe it to yourself to at least take a

  • look and consider your options . Go to healthcare.gov and see how much insurance is going to cost

  • you. It's not going to be as scary as you've been told. Even if it's not as awesome as

  • getting health care from aliens.

Hi I'm Dr Aaron Carroll. And in this new youtube show we are going to try and help you under stand how medical

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