Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

npr.org

Post reply on HN
Print view View original

201–210 of 387 posts

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

#201

Post by snowwrestler »

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…

Published medical prices are not real because most procedures are paid by collective programs like private insurance or Medicare, which use their bargaining power to pay less--sometimes MUCH less--than the public "list price".

You're right that the complexity of medical billing also makes it difficult to anticipate and compare prices. However, that might be more of a side effect of how the billing is done, rather than an unavoidable attribute of medical care.

Arguably, medical providers have the information and capability to package procedures and publish what it actually costs to do them. But they have no incentive to do so, and many incentives to not do so.

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

#202

Post by mikestew »

rayiner wrote: post #175
jseliger wrote: post #69

Earlier quoted context omitted.

But it's been tough for people who were already covered by employer insurance. Yes. The only word I disagree with in the headline is "start." The squeeze started years ago. One way to look at the problem is this way: http://seliger.com/2018/11/11/health-insurance-security-fqhc... : In Northern Virginia, for example, the cheapest 2019 Obamacare individual market Silver plan for a family of four (mom and dad age-40) ma…

At least that premium is totally reasonable. In Germany, the health insurance tax is 15%, half paid by the employer and half by the employer (and it’s not progressive like the ACA subsidy). $4,500 per year is 7% of income, lower than what the employer-side tax alone would be in Germany.

Now do the math when you include total out-of-pocket. My napkin says: "Considerably more than 15%". (Unless I misremember, and the 15% German tax doesn't cover the vast majority of cost.) Not to dismiss your point completely, but I could sell you insurance for $1/year, but your total out-of-pocket cost is going to be considerably more than $1.

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

#203

Post by weberc2 »

llamataboot wrote: post #146
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…

All of us with pre-existing conditions that couldn't buy insurance no matter the cost feel different of course, but you acknowledge that. I'm interested in why you think ACA itself has made anything worse. Surely premiums have gotten worse, but it's not clear to me how it is nec linked to the ACA. (And it should be said that the insurance industry basically wrote large portions of the ACA, and arguably its weakest pa…

ACA requires insurers to cover pre-existing conditions. That's a cost that needs to be recovered, and most of that additional coverage comes by increasing premiums. Ergo, ACA increases premiums.

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

#204

Post by weberc2 »

CarriersSuck wrote: post #183
WrtCdEvrydy wrote: post #117

Earlier quoted context omitted.

Individualism in America is the main cause... if you just got taxed and didn't have to worry about healthcare, people wouldn't care, but they all think that it could never happen to them.

Americans think the poor are slackers and they don't deserve anything. Even poor Americans think the "other" poor are slackers and don't deserve anything. Nothing will change until you change this mindset.

This is a pretty bold statement. How many Americans do you know?

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

#205

Post by ctchocula »

mrosett wrote: post #83
rockinghigh wrote: post #56

Earlier quoted context omitted.

The increase in high-deductible health plans (HDHP) enrollment predates the ACA by many years. You can look at the trend here: https://www.cdc.gov/nchs/products/databriefs/db317.htm Their role is to protect against very high bill of $5,000 and up due to major surgeries, illness, pregnancy, and so on. They should definitely be completed by a health savings account (HSA) for day-to-day coverage.

That's interesting data. Thanks for sharing it. In the 2017 snapshot, I'm surprised to see that HDHP plans are slightly more common for high-income families. I didn't expect that. There's a missing variable here: What are the premiums? HDHPs are attractive to insurers (and by extension employers) because they increase employee sensitivity to healthcare costs and may lead to less wasteful spending. Advocates emphasize…

I imagine it's because it provides a way to sock away $7k each year in a retirement fund that can be invested in index funds and won't get taxed after 65 on qualified medical expenses making it more valuable than either traditional or Roth IRAs that get taxed on withdrawal and when you put the money in respectively. High-income families have the spare cash to do that, so for them it's a valuable investment vehicle.

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

#206

Post by brazzledazzle »

mrosett wrote: post #165
ComputerGuru wrote: post #153

Earlier quoted context omitted.

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

That's a slightly maddening thing about many these comments. If you were getting your healthcare through an employer, you had a lot more security both on the pre-existing conditions end and on the keeping coverage end.

I remember several stories in the news before the ACA about employees being pressured to find private insurance or even getting fired because they were raising the group plan's costs. Are you sure it's so cut and dry that it's something you should be maddened about?

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

#207

Post by lotsofpulp »

ixwt wrote: post #163
lotsofpulp wrote: post #138

Earlier quoted context omitted.

Correct. There's a higher contribution limit ($7k in 2019) if you have family HDHP coverage. Also, after retirement, money can be withdrawn without paying the 10% penalty and just paying the regular income tax, in case you don't have receipts for medical payments from the past. I wonder how the IRS would prevent a tax evader using the same receipts for payments for medical expenses for different withdrawals in differ…

I would assume if you got audited, you would have to justify all withdraws. I doubt they would be impressed with multiple copies of the same receipt.

How many years do you get audited for? I thought it was just 7. So if you use it every decade, I presume they’re not going through every year and it wouldn’t be seen. Unless they’re keeping a database.

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

#208

Post by cmuguythrow »

CptFribble wrote: post #196

Every discussion on healthcare payment structures in this country is completely asinine. Healthcare is best managed as a risk pool. The bigger the pool, the cheaper to be in it. The biggest risk pool is everyone. Therefore, we should put everyone in a single pool. How we manage this is a separate discussion. Private, public, maybe a federally chartered non-profit like the Fed. But as long as we keep ourselves fractur…

To be fair, this perspective does assume that people care about the health of society as a whole. If you're willing to let others get substandard care or even die, it may be more optimal for you to have your own smaller, lower-risk pool with better benefits.

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

#209

Post by jack4mdetriot »

tptacek wrote: post #4

Isn't the point of an HDHP that you're supposed to set up an HSA to go with it? Premiums for HDHPs are significantly lower than for normal health plans; the idea is that you're supposed to use the premium savings to fund the HSA, which is then money that carries over year over year, right?

Example HDHP plan where you pay $30 every month Full price at doctors, deductible of 5k (80/20 after), max out of pocket 10k Setup HSA to contribute $200 every month (tax benefit) If you go to doctor 2-4 times a year for minor stuff it works out great for you. If you use if for 4-5 years, savings add up and have some security in the future towards medical related costs.

Does not seem to work great for families with kids or someone who frequently visit the doctors, for young singles with no health issues it can work out great.

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

#210

Post by [deleted] »

CptFribble wrote: post #196

Every discussion on healthcare payment structures in this country is completely asinine. Healthcare is best managed as a risk pool. The bigger the pool, the cheaper to be in it. The biggest risk pool is everyone. Therefore, we should put everyone in a single pool. How we manage this is a separate discussion. Private, public, maybe a federally chartered non-profit like the Fed. But as long as we keep ourselves fractur…

[deleted]
Post reply on HN