Iskaral Pust

US Healthcare insurance

102 posts in this topic

Since we are entering the time of year when most US employers go through open enrollment, I'd like to get a broad range of reactions to healthcare costs. 

My health insurance just increased by 30% on a high deductible plan (BCBS silver tier plan), and the maximum out-of-pocket on the policy jumped a lot too.  My company comprises well educated, professional class white-collar employees with all of the wellness nudges and preventative care coverage.  This is a relatively healthy population.  We've had annual increases above 20% every recent year.

HR is trying to placate an enraged mob on this topic and their standard answer is that health insurers are raising prices aggressively on employer plans to recover losses on the influx of ACA individual policies.  

In a high deductible plan, I basically pay for 100% of our health care costs each year out-of-pocket.  That includes paying $700+ for an epipen, despite Mylan saying those inflated prices aren't actually paid by anyone.  So $15k a year, from me and my employer combined, goes to the health insurance company to pay for other people's health care, while I pay for all of our actual healthcare at inflated prices that get discounted if/when they revert to the insurance company.  That $15k a year only benefits me if I or my wife or son require some extraordinary medical treatment.

It sure seems like we have socialized healthcare already, but with all of the cost sharing and none of the cost controls.  Even with a reasonably generous employer healthcare plan, I'm getting tempted to drop coverage and self-insure.  

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premiums used toward other members of the risk pool is standard insurance, no?

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I've been incredibly fortunate to work for Microsoft, which still has one of the best healthcare plans in the nation. And even it got dinged.

When ACA came out, it went from basically 100% coverage of everything in network, forever, to a HSA plan with a deductible and copay up to $6250 total. That sucked - it was basically like having a 6k loss of income every year for us given that it was for our entire family - but it was still pretty good. And with the treatments we've had this year for my son's cancer, it's shown how incredibly good it is. 

I can't imagine getting better insurance than I have now, and what I am paying now would cost absurd amounts if done privately.

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This was obviously going to happen at some point -- simple mathematics demands it. The costs of health care did not go down (there's debate over whether the rate of increase slowed or not, but that they were in fact increasing is an undisputed fact) and more people were receiving it. The government paid part of the cost for the latter, but not all of it as its resources are limited. The insurance companies aren't going to operate at a loss so somebody had to make up the difference -- and that would be everyone who can afford to pay more.

The insurance payments at my university did not dramatically increase over the 5 years that I have worked there. However, just as with your plan, it is only meaningful for catastrophic coverage and I have paid 95% of the costs for the routine medical treatment I've needed out of pocket. In a way it's pretty impressive how they've thought of practically everything that is likely to trouble a mostly healthy person in their late 20s to early 30s and excluded all of it from coverage.

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Seems like most companies are going the HSA model, mine included.  Next year I pay an increased premium for my existing plan, but the year after, they drop that plan (and many others) and offer only CDHP options.

Pretty shitty, to be honest.  Even the HSA premiums are going up, and the benefits going down.

Not sure how much of this is driven by the Cadillac tax (which I know has been delayed) and how much is driven by the increase in premium due to the increased cost of Obamacare coverage to insurance companies, but it's...  Sub optimal.

 

 

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My employer offered plan actually decreased a couple dollars a month this year.  Ours went into effect 10/1.  We have a 5,000 deductible  per person but 10,000 maximum per family, so it's not too bad.

Also, regular check ups as well as specialist visits have a pretty low copay.

The major change for us this year was dental went up about 5 bucks a pay, and they only cover children to age 18 now.  Previously they covered children on our dental to 26. As I have two that are between 18 and 26, they lost their dental coverage.

But, back in 09 when I was looking for healthcare, we were offered a plan, 1,500 dollars per month.  Per month!  With a 7,500 deductible per person. So, i'm definitely not complaining these days.

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I gotta say, the best part of working for a hospital is I pay next to nothing for premium health and dental insurance. $75 a month for a $500 deductible and my healthcare costs are basically capped annually at $20,000. This is the individual plan. A family of four (or more) is about $275 a month, but still only has a $500 deductible and the annual cap is around $50,000.  

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1 hour ago, Kalbear said:

I've been incredibly fortunate to work for Microsoft, which still has one of the best healthcare plans in the nation. And even it got dinged.

When ACA came out, it went from basically 100% coverage of everything in network, forever, to a HSA plan with a deductible and copay up to $6250 total. That sucked - it was basically like having a 6k loss of income every year for us given that it was for our entire family - but it was still pretty good. And with the treatments we've had this year for my son's cancer, it's shown how incredibly good it is. 

I can't imagine getting better insurance than I have now, and what I am paying now would cost absurd amounts if done privately.

I work for a similar company, not exactly MS but close and we have a similar plan. We got weened offthe cadillac PPO plan and moved to the higher deductible HSA. There was a lot of complaining which is ironic because I work in Cambridge, MA which is the epicenter of the weeny liberal movement in the northeast. You should have seen all the pony tail, skinny jeans,  flip flop wearing anger coming out during the HR seminars. :)  

The best feature of the HSA is the program that matched our contributions up to $1500 on a flexible spending account that rolls over year to year. The timing for this was most fortunate for me because I had to get invisalign and my three daughters all had to start braces over the last couple of years. Even more fortunate is that they did the $1500 dump at the beginning of the year for the first year to get people ahead on their accounts. That was a one time thing but it has allowed me to cover the ortho expenses using pre tax contributions, matching money plus we have a one time $1250 ortho benefit. I would have had to pay out of pocket using the old system. Cost continue to go up but I do like the flexibility. I've never had to dig into my bank account for any prescriptions, dentist appointments, co-pays etc. Im always ahead on my account so I like having the cushion of money sitting there when we need it. 

 

Edited by zelticgar

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Kalbear - I'm so sorry to hear about your son.  I hope the treatment is going well.

Solo - of course that's the point of insurance pooling, but it's a question of relative value and risk.  The vast majority of working-age health care cost is incurred by a tiny minority with critical illness that require expensive treatment forever.  Most people use only routine health care, but the total premium (emp'ee + emp'er) plus HSA contribution exceeds $20k -- that's half of median income!  

Actuarially, there is no justification for healthy people to pay that.  Their risk of suddenly becoming critically ill is quite low.  Most critically ill have been critically ill for most of their lives.  Some people do have those sudden health shocks but very few and most recover or die before the health care cost gets enormous.  If we were charged actuarial premiums based on our individual risk - like auto insurance - it would be much lower.  Insurance companies have a surcharge now for tobacco, but no-one has a discount for my diet, exercise and other lifestyle choices.  So pooled healthcare costs are effectively a tax on your good fortune to not be born with congenital conditions or morbidly obese.  And perhaps we're willing to pay that out of relief and empathy, but up to what point?

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i hear you.  risk management, though, right? my last physical examination turned out WNL results on every single value, so i do not expect to have any fugly health problems.  am as yet still paying $500 per month for my and daughter's high deductible health plan as against the unlikely contingency.

i'm not willing to place the costs of congenital conditions or morbid obesity, say, on the persons afflicted thereby, as they strike me fundamentally as externalities borne by those persons aforesaid; the collective can internalize those costs, and is more able to bear them.  perhaps the bearing of same might be apportioned more reasonably, of course.

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I really dont want to derail the thread but can someone explain to me why do the US have such morbid prices in healthcare? I live in greece where everything is in a permanent state of dissaray and i had surgery(private luxurius clinic) perfomed by two specialist doctors, (one of the top ourologists) anaesthesian and microscope operator for 1200$.  

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capitalism is a state of permanent disarray.  obviously y'all have too many physicians if medical care is reasonably affordable. i recommend that you fire most of your physicians and thereby bring your marginal rates into alignment with proper exorbitant pricing structures.

Edited by sologdin

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I said right from the start the math on the ACA did not add up, and that Obama would be lucky to finish his term before it collapsed.  As usual, I got called 'delusional' among other things by the posters here.

 

Insurers are pulling out of the Marketplace - they hoped to snag a bunch of rich 'young Invincible's' (a idiotic notion in the first place) and apparently never even considered the possibility that there were large numbers of people with severe medical conditions in the US who would take advantage of the program - also an act of complete idiocy.)    In my area, I get to change insurer's in the next couple of months because the so called 'Marketplace' drops from two companies to one.  My current insurer is pretty much worthless - if memory serves, they covered about a hundred bucks out of a about five times that for my recent doctors visits.  The payments are high, and the deductibles are obscene.  Their replacement was kind enough to let us know the tabs will damn near double next year.  So, given that, is it worth it?

 

My take was always this:  You want to make health care affordable, then you attack the costs directly, at the source.  Massive, across the board price controls for specified procedures with severe penalties on the providers part for exceeding those costs without damn good reason.  No more of this 'Hospital A charging $2000 for a procedure while Hospital B across town charges $20,000.'  That was never anything but criminal price gouging, and is the main reason for why medical care costs so much in the US. 

 

As to paying for it - expand Medicaid to cover everybody.  You draw a paycheck or a salary, Medicaid is taken out of the check, right off the top anyhow.  Even minimum wage workers end up contributing a few hundred bucks each year into this already.  If need be triple the relevant tax. 

Now this is where half the board says I am delusional once again, that these measures would have a negative impact on the economy, politically impossible, and similar nonsense. 

 

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no crazy there, thinkerx.  monopsony purchaser will crush the medical industry back to reasonableness.

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Open enrollment is next month for us, I think.

I pay about $300/ month for a PCP system with $15/$20/$10 copays for doctor visits and medications (as well as some free medication they throw in as well). So far its been quite good, particularly since I had a pre-existing condition when I joined my company. With 5 people to insure it isn't too bad. It'll be interesting to see how much things go up for my plans this year. Until now the effect of the ACA has been marginal at best.

Our pool is big enough within the US that I think we wont see monumental changes.

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ThinkerX - you're right and we've agreed on this before.  Health care is too asymmetrical to function as an open market.  It needs to be a public good with price control and rationing by value offered (aka death panels).  It's incredible that we're still stuck on this hamster wheel of exploitation. 

Solo - empathy shouldn't extend to everyone with employer health care spending half the median annual income each year.   We've lost all sanity and sense of proportion here.  The median family spends $20k a year for routine annual check-ups and a refresh on their epipen.  We're stuck in a trap of fear and pity.

Koudalis - it costs so much because doctors are so well paid (in part because they have to finance their own education), because of malpractice lawsuits, because almost the entire global pharmaceutical and medical device profits come just from the US, because we're the only country that allows consumer marketing of pharmaceuticals and direct marketing to doctors by the hot pharma-bunnies, and because we spend vast amounts to extend a few months of "life" for people who are clearly dying.   In fact, it's almost identical to the trap that has generated trillions in student loans. 

There's no escaping it: Obama's ACA was the most craven compromise imaginable. We should be almost a decade into universal healthcare, instead we just expanded the original problem.  

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Didn't bother with health insurance this year. I left my work 8 months ago and have spent the time visiting family, site seeing, and pretty much just having fun.  Took the risk that in this time I wouldn't get seriously injured or ill, because the cost for paying for health insurance was more than I was willing to pay (cheapest plan I could find for myself would've cost more than $200 a month) Really looking forward to paying that $695 penalty though, considering the last time I visited a hospital for an illness/injury was when I was in elementary school over a decade ago. 

Edited by A True Kaniggit

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18 hours ago, Iskaral Pust said:

Insurance companies have a surcharge now for tobacco, but no-one has a discount for my diet, exercise and other lifestyle choices.  So pooled healthcare costs are effectively a tax on your good fortune to not be born with congenital conditions or morbidly obese.  And perhaps we're willing to pay that out of relief and empathy, but up to what point?

Well, smoking is a major cardiovascular risk factor and has all sorts of other consequences. However, it is also a "modifiable" risk factor and is probably the only major one that has clear, direct causative associations. But maybe people should get a discount if they get their 10,000 daily steps? How finely grained should premiums be? 

Significant congenital conditions are uncommon, but chronic diseases like Crohn's/IBD amongst many others are not. Young people don't usually get cancer, but they can and do. They also get injured. 

Do you have an alternative?

12 hours ago, Iskaral Pust said:

ThinkerX - you're right and we've agreed on this before.  Health care is too asymmetrical to function as an open market.  It needs to be a public good with price control and rationing by value offered (aka death panels).  It's incredible that we're still stuck on this hamster wheel of exploitation. 

Solo - empathy shouldn't extend to everyone with employer health care spending half the median annual income each year.   We've lost all sanity and sense of proportion here.  The median family spends $20k a year for routine annual check-ups and a refresh on their epipen.  We're stuck in a trap of fear and pity.

Koudalis - it costs so much because doctors are so well paid (in part because they have to finance their own education), because of malpractice lawsuits, because almost the entire global pharmaceutical and medical device profits come just from the US, because we're the only country that allows consumer marketing of pharmaceuticals and direct marketing to doctors by the hot pharma-bunnies, and because we spend vast amounts to extend a few months of "life" for people who are clearly dying.   In fact, it's almost identical to the trap that has generated trillions in student loans. 

There's no escaping it: Obama's ACA was the most craven compromise imaginable. We should be almost a decade into universal healthcare, instead we just expanded the original problem.  

The trick is settling on a model for social insurance, universal public coverage, extent of co-pays, coverage of pharma, PT, extended health, long-term care... I don't really know what the solution is. 

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2 hours ago, Aemon Stark said:

The trick is settling on a model for social insurance, universal public coverage, extent of co-pays, coverage of pharma, PT, extended health, long-term care... I don't really know what the solution is. 

The solution is to drop the ridiculous insurance-based model entirely; nationalise all the hospitals and pharmaceutical companies, and provide all reasonable health care to whoever needs it free of charge. Fund it via higher taxes; the total cost will be a great deal less, since it eliminates profit margins, plus all the insurance and billing bureaucracy.

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The ACA hasn't collapsed. It isn't close to collapse. As usual, @ThinkerX was called delusional because you said something very delusional.

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