Employees Start to Feel the Squeeze of High-Deductible Health Plans • Hacker News Board

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#151

Post by Buttons840 » Fri, May 03, 2019, 7:02 PM UTC

civility wrote: post #137

bliblah wrote: post #67

Earlier quoted context omitted.

>> just needs to be actually thought through, It's impossible because you both political parties want exclusively mutual results You can't have cheap insurance without making it mandatory since only the sick will get it You can't have easily accessible insurance without forcing healthcare companies to comply with new regulations forcing them to increase costs You can't have good insurance if you aren't willing to pay…

> You cant lower costs in the US without having a more aggressive regulatory body which 50% of political bodies strongly oppose alongside lobbying efforts Here is the fundamental problem from my point of view. Compare human medical costs to veterinary costs. Yes, people expect a slightly higher standard for themselves than they do their animals, but you can get a major knee surgery for your dog for a small fraction o…

They do have to publish prices, right? See: https://www.google.com/search?q=doctors+and+hospitals+must+p...

Maybe these aren't the "true prices"? I certainly wouldn't know where to look to find how much a "knee surgery" would cost, and I'd probably need to know some obscure medical code I don't have access to, as well as the intricacies of the knee surgery to know exactly what price to look up. I don't know how publishing "true prices" would work.

What kind of knee surgery am I having? Will I have to pay extra for the anesthesiologist? What kind of anesthesia will they be using? What about surgery preparation? What costs do I need to include for that? What about post surgery? There's probably a dozen cost items to add to the total for post surgery. The nurse brought me a glass of water. I'm not sure if that comes with a charge or not? Presumably someone has to pay for the plastic cup. Etc.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#152

Post by everdev » Fri, May 03, 2019, 7:03 PM UTC

refurb wrote: post #125

tptacek wrote: post #113

Earlier quoted context omitted.

If you're saying the ACA didn't completely fix the US healthcare system, I strongly agree. If you're saying the ACA harmed the health care system, strong disagree. Again: the cost increases you're talking about were a fact of life before the ACA. There is no evidence that your costs would have leveled off without the ACA, and substantial evidence that the opposite would have happened.

The increase in costs were most certainly driven in part by the ACA changes. No longer allowed to deny based on pre-existing conditions? Insurers need higher rates to cover those costs. Require a bunch of things be added to mandatory preventive visits? Those have to be paid for as well. That said, I agree the costs would have continued to go up, but to say there is no evidence that the ACA contributed to it is just i…

I had the same experience where as a sole proprietor health insurance for a family of 5 is now $2,000/month. $24k/year not for great healthcare, but for the privilege of paying a "discounted rate" on "select services" when you actually need healthcare.

We haven't needed the coverage for two years but when we did, what we needed wasn't covered so we paid full price anyway including $80 for a bottle of Ibuprofen that was casually offered to us. The markups are almost criminal.

For a $1M home you can find insurance for $1,500 per year. It's exponentially less expensive.

ACA was the worst possible compromise to a serious problem. A public option, universal healthcare or deregulation all would have been better options.

It'd be much nicer to be able pay a doctor to make house calls as needed and waive your right to a malpractice lawsuit than to pay to support this insurance/legal/government system we have now.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#153

Post by ComputerGuru » Fri, May 03, 2019, 7:05 PM UTC

JMTQp8lwXL wrote: post #87

mrosett wrote: post #2

You can argue that the ACA improved the healthcare system overall. But it's been tough for people who were already covered by employer insurance. I think people fail to appreciate that prior to the ACA, when the healthcare system worked, it actually worked really well. I got very sick at the age of 20 while I was still on my parents very modest insurance (pre-ACA). Within 48 hours I had an appointment at the best onc…

Pre ACA, pre-existing conditions could disqualify you from insurance. People with pre-existing conditions are the people that need health care coverage the most. We can't under-weigh the moral obligation we have to this previously marginalized group, when considering service may be slightly worse for people who have employer coverage. How I see it: if you were in the pre-ACA pre-existing condition pool, your perspect…

AFAIK, preexisting conditions weren't a disqualifier for any employer-provided health insurance (which is why group policies are so expensive).

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#154

Post by lamarpye » Fri, May 03, 2019, 7:05 PM UTC

JMTQp8lwXL wrote: post #87

mrosett wrote: post #2

You can argue that the ACA improved the healthcare system overall. But it's been tough for people who were already covered by employer insurance. I think people fail to appreciate that prior to the ACA, when the healthcare system worked, it actually worked really well. I got very sick at the age of 20 while I was still on my parents very modest insurance (pre-ACA). Within 48 hours I had an appointment at the best onc…

Pre ACA, pre-existing conditions could disqualify you from insurance. People with pre-existing conditions are the people that need health care coverage the most. We can't under-weigh the moral obligation we have to this previously marginalized group, when considering service may be slightly worse for people who have employer coverage. How I see it: if you were in the pre-ACA pre-existing condition pool, your perspect…

Was the ACA the best to address the problem of pre-existing conditions?

https://www.theatlantic.com/business/archive/2011/06/why-has...

"There were supposed to be millions of people who were uninsurable because of pre-existing conditions. We heard lengthy testimony about their terrible plight. I don't think it's too strong to say that this fear--that you could get sick and no one would insure you, that's right, you, Mr. & Mrs. Middle-Class Voter--was one of the main reasons offered for the health care overhaul. It was estimated by Medicare's Chief Actuary that around 400,000 would sign up (the CBO estimated 200,000, but only because they assumed that HHS would use its authority to limit enrollment in order to stay within the $5 billion budgeted for the program). So where are all the uninsurable people?"

So if this is accurate, that is the size of risk pool isn't that large. Wouldn't be better to create a special program for people who fall into this category?

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#155

Post by mieseratte » Fri, May 03, 2019, 7:05 PM UTC

tptacek wrote: post #113

mieseratte wrote: post #72

Earlier quoted context omitted.

I signed up for the ACA the year it came online. Over the years I went from a sub-$100 plan that actually covered things to paying $300+ per month for the "hit by a bus" plan that was so expensive, one year I said fuck it and paid the penalty instead. I understand well what could have been had something truly happened, but I ended up saving money paying the penalty while still having a few minor doc-in-a-box visits o…

If you're saying the ACA didn't completely fix the US healthcare system, I strongly agree. If you're saying the ACA harmed the health care system, strong disagree. Again: the cost increases you're talking about were a fact of life before the ACA. There is no evidence that your costs would have leveled off without the ACA, and substantial evidence that the opposite would have happened.

> If you're saying the ACA harmed the health care system, strong disagree.

The system? No. Corporate welfare is great for "the system." But the consumers? Absolutely harmed!

> Again: the cost increases you're talking about were a fact of life before the ACA.

I've been working for over a decade now. 100% increases, year-over-year have never been even close to a thing with employer plans I've held. Not even close. Typically something in the realm of $20 per year at worst for a quality plan.

Here is another fun anecdote. I recently lost a job, and my firm was too small, with only 4 insured, to qualify for the COBRA. Total premium for the plan was roughly $150, roughly $75 per party as my employer paid 50%. Comparable coverage through the same insurer through the marketplace would have cost me nearly 4x as much.

The reality is the ACA allows insurance firms to sell obscenely over-priced plans to consumers. A sane system would have seen price controls in conjunction with the requirement for insurance. Instead I am forced to pay an insurer, pay the government, or prison. I would happily pay taxes for a fully nationalized system, but the ACA is obscene.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#156

Post by jandrewrogers » Fri, May 03, 2019, 7:06 PM UTC

pnutjam wrote: post #71

jandrewrogers wrote: post #54

Earlier quoted context omitted.

The cost to employers of very good plans massively increased after ACA went into effect. When this changeover happened, I was running a company where we paid 100% for one of the best healthcare plans available in the state for both the employees and their families -- people really appreciated this benefit. This was the polar opposite of a "crappy plan", and it wasn't inexpensive to begin with. After the ACA, this pla…

What was the lifetime max on this plan? It probably would have left people out in the cold when they most needed it. I don't think it's wrong to expect insurance to cover people when they most need it, which was largely not true with million dollar lifetime caps. Even with the ACA, employers have the best of both worlds. Expensive older people are covered by the government, and anyone who gets to expensive can be shu…

The lifetime max was multiple millions, I don't remember the exact number. As I stated, it was just about the best policy available for any amount of money. There is no credible way to spin this as actually being worse for those employees. I like to hire "expensive older" engineers, so dialing healthcare benefits up to eleven was intended to attract that kind of employee.

All insurance policies have implicit lifetime maximums, unless the laws of economics and finance have been repealed.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#157

Post by dsfyu404ed » Fri, May 03, 2019, 7:08 PM UTC

Buttons840 wrote: post #151

civility wrote: post #137

Earlier quoted context omitted.

> You cant lower costs in the US without having a more aggressive regulatory body which 50% of political bodies strongly oppose alongside lobbying efforts Here is the fundamental problem from my point of view. Compare human medical costs to veterinary costs. Yes, people expect a slightly higher standard for themselves than they do their animals, but you can get a major knee surgery for your dog for a small fraction o…

They do have to publish prices, right? See: https://www.google.com/search?q=doctors+and+hospitals+must+p... Maybe these aren't the "true prices"? I certainly wouldn't know where to look to find how much a "knee surgery" would cost, and I'd probably need to know some obscure medical code I don't have access to, as well as the intricacies of the knee surgery to know exactly what price to look up. I don't know how publi…

>Maybe these aren't the "true prices"? I certainly wouldn't know where to look to find how much a "knee surgery" would cost, and I'd probably need to know some obscure medical code I don't have access to, as well as the intricacies of the knee surgery to know exactly what price to look up. I don't know how publishing "true prices" would work.

This is exactly the problem. They publish "prices" but those prices don't mean anything.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#158

Post by newsoul2019 » Fri, May 03, 2019, 7:08 PM UTC

JMTQp8lwXL wrote: post #87

mrosett wrote: post #2

You can argue that the ACA improved the healthcare system overall. But it's been tough for people who were already covered by employer insurance. I think people fail to appreciate that prior to the ACA, when the healthcare system worked, it actually worked really well. I got very sick at the age of 20 while I was still on my parents very modest insurance (pre-ACA). Within 48 hours I had an appointment at the best onc…

Pre ACA, pre-existing conditions could disqualify you from insurance. People with pre-existing conditions are the people that need health care coverage the most. We can't under-weigh the moral obligation we have to this previously marginalized group, when considering service may be slightly worse for people who have employer coverage. How I see it: if you were in the pre-ACA pre-existing condition pool, your perspect…

I don't like the entire concept of "pre-existing conditions". It goes against the entire concept of caring for sick people.

We are all people. We all get sick sometimes. Sicknesses can last a long time, or a short time. Sick people need help. Help the sick people. Pay what you can (a reasonable amount) into a common pool and take what you need (only as much as you need)

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#159

Post by lotsofpulp » Fri, May 03, 2019, 7:08 PM UTC

rb808 wrote: post #149

lotsofpulp wrote: post #140

Earlier quoted context omitted.

What? It takes 5 minutes to open a free HSA account at Fidelity and transfer funds to it.

I didn't know they were available. I thought it could be open to everyone, but employer ones do have advantages. https://www.fidelity.com/go/hsa/why-hsa > You could also use it in place of an employer HSA. If you do this, you may miss out on opportunities like pre-tax payroll or employer contributions, so check with your employer to see what they offer.

You can still deduct contributions from income taxes, and you can also transfer funds after contributing to your employer sponsored HSA to your individual one.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#160

Post by frenchman_in_ny » Fri, May 03, 2019, 7:13 PM UTC

WrtCdEvrydy wrote: post #108

JMTQp8lwXL wrote: post #87

Earlier quoted context omitted.

Pre ACA, pre-existing conditions could disqualify you from insurance. People with pre-existing conditions are the people that need health care coverage the most. We can't under-weigh the moral obligation we have to this previously marginalized group, when considering service may be slightly worse for people who have employer coverage. How I see it: if you were in the pre-ACA pre-existing condition pool, your perspect…

My favorite one was pregnancy being a pre-existing condition so if your husband got fired (noone would ever fire a pregnant woman for no reason), you couldn't get insurance when you needed it the most.

Though (if both spouses were working & had access to employer sponsored insurance), wouldn't the husband being fired result in a qualifying change for the woman, allowing her to enroll on her employer's insurance plan, thus covering the pregnancy?