But haven't health care costs gone up for your patients? Did you see a lot of 10k deductibles before Obama care? How much is a non poverty family paying for insurance now vs before? In my middle class / upper middle class group people have ended up with shittier insurance and higher costs. Although I do agree that there are now more people that have insurance, many of those that do cannot afford the deductible on the services they need.
The ones who had insurance before, nope. They pay what they always have. The ones who now have insurance but didn't before? No idea, they didn't have any before. I have yet to see a 10k deductible. From my side of things, all I know is if a person has coverage or doesn't. And from what I've heard from my veteran coworkers, there has been a significant decrease in the amount of people saying they have no insurance.
At the moment I can only prove Higher costs, but it was more of a failure to stop a trend than an obvious dislocation caused by the change: Source: http://files.kff.org/attachment/summary-of-findings-2015-employer-health-benefits-survey
There's more to it than deductibles. Prevention is really the part you aren't grasping here. Right now, a huge part of why costs are so high is because of the no-pay rate in Emergency rooms and lots of other outpatient clinics, so the people who do have to pay, pay more. Prevention, annual checkups, nutrition counseling and better access to primary care providers, among other things, lowers the amount of people who use the emergency room as a one stop medical shop, which again, jacks up costs for everybody.
Its interesting that you mention that. The data I linked seemed to show a steady increasing trend in healthcare costs paid but no spike (see exhibit B ) but the increased access is a factor I hadn't considered. Like you said a large part of the cost should be because of the uncompensated care rate Effectively middle class Americans are still paying the same huge costs as they were with lots of uncompensated cost but they are also paying for the expansion of medicaid that they weren't paying for before. As for prevention I agree that more people are using their free annual checkup but I'm not sure how much more likely they are to use primary care considering 40-60 percent of workers have a deductible over 1k [(see graph on exhibit G) ](http://files.kff.org/attachment/summary-of-findings-2015-employer-health-benefits-survey) and less than half of Americans have $1,000 in savings. The current structure still makes many of those services inaccessible to those who would benefit most.
best chart I could find (old from 2014). But if uncompensated care has gone down, drastically but patient costs have have continued to climb at previous rates that is the the huge spike. Its just hidden by the medicaid expansion. So i'm not off the rails like tacocat might imply (BTW exhibit G shows % of plans with over 1k deductible).