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

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

#211

Post by rayiner »

mikestew wrote: post #202
rayiner wrote: post #175

Earlier quoted context omitted.

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.

The out-of-pocket max is something you’re likely to hit only if you get sick. The 15% is something you have to pay every year.

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

#212

Post by [deleted] »

cmuguythrow wrote: post #208
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.

[deleted]

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

#213

Post by _bxg1 »

Healthcare simply does not line up with the incentive structure of the free market.

People can't opt-out if they're getting a bad deal.

Risk outliers get turned down as bad business decisions, or the drugs they need to stay alive are impossible to afford because of "low" demand.

It's left up to employers to choose the product that's best for their employees (and ensure that market competition functions), but that assumes they actually care about their employees' well-being, which most don't.

Denying care to the unemployed is a strong force deepening the poverty cycle, preventing people from working their way back up to being productive members of society.

Healthcare doesn't even really fit the model of insurance, because it isn't just a guard against unlikely catastrophe, it's an ongoing, chronic, inevitable cost of being a human being.

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

#214

Post by FireBeyond »

cmuguythrow wrote: post #208
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.

Right. And therein lies the rub. The US is quite possibly one of the worst in the world for "Fuck you I got mine" (until you don't got yours). And then there's the cognitive dissonance of people who might have otherwise screamed about "socialized medicine" who find themselves on the unlucky end of a diagnosis and are singing a different tune (or sometimes still singing the same tune, even as they put up a GoFundMe...).

How many other countries in the world consider medical bankruptcy a thing to be accepted and tolerated?

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

#215

Post by SlowRobotAhead »

briffle wrote: post #126
LarryDarrell wrote: post #60

If you were designing a society starting from scratch today and said, "I think we should make having health insurance largely dependent on having an employer.", you would be laughed out of the room. I think we are running along some tracks that were laid long ago, and rather than all jumping off, some people in comfy Pullman cars are content with letting the train run off a cliff.

I find it odd that some executive gets to pick which 401k and health insurance plans you get, and that you must pick from their few choices that allow you to have. I can see why the providers love it, they can target all their advertising, marketing, etc, at a few key people at large employers, but not sure how that benefits the average worker..

You can get an individual 401K or IRA and make all your own choices. If you're talking about an employer matched 401K, I don't think it's unreasonable at all for them to select it.

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

#216

Post by rayiner »

mattlondon wrote: post #177
rayiner wrote: post #167

Earlier quoted context omitted.

> 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. Note that lifetime caps are a lot more generous than what they have in say the UK, where you don’t get treatment if it costs more than $50-75k per year of…

> Note that lifetime caps are a lot more generous than what they have in say the UK, where you don’t get treatment if it costs more than $50-75k per year of extended life Do you have any data for that? Sounds odd.

https://www.bbc.co.uk/news/health-28983924. It’s not odd at all. It’s a basic thing that makes the UK’s health system work. US insurers (in the past) would piss away a half a million or a million on uncertain treatments. (And then the family would go out of pocket, go broke, and there would be an article on medical bankruptcies.) The UK doesn’t do that. Instead, it’s very aggressive about justifying costs with expected outcomes.

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

#217

Post by creato »

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…

> No longer allowed to deny based on pre-existing conditions? Insurers need higher rates to cover those costs.

Is there any alternative though? We're going to pay those costs one way or another: either the government pays for all the unprofitable patients' healthcare (the wet dream of health insurers), or we tell those people to go fuck themselves.

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

#218

Post by snowwrestler »

LarryDarrell wrote: post #60

If you were designing a society starting from scratch today and said, "I think we should make having health insurance largely dependent on having an employer.", you would be laughed out of the room. I think we are running along some tracks that were laid long ago, and rather than all jumping off, some people in comfy Pullman cars are content with letting the train run off a cliff.

If I was designing a society from scratch, I don't think I would create "insurance" that is expected to pay for almost every routine, non-emergency, completely predictable cost just because it's a medical cost.

The employer-provided system--which arose out of WWII-era wage controls, for those who don't know--has not only created the "have/have not" dichotomy in U.S. healthcare, it has also warped expectations about what "insurance" is supposed to cover--and broken normal pricing mechanisms.

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

#219

Post by [deleted] »

lamarpye wrote: post #154
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…

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,…

[deleted]

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

#220

Post by rayiner »

FireBeyond wrote: post #214
cmuguythrow wrote: post #208

Earlier quoted context omitted.

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.

Right. And therein lies the rub. The US is quite possibly one of the worst in the world for "Fuck you I got mine" (until you don't got yours). And then there's the cognitive dissonance of people who might have otherwise screamed about "socialized medicine" who find themselves on the unlucky end of a diagnosis and are singing a different tune (or sometimes still singing the same tune, even as they put up a GoFundMe...…

By contrast, would the US be able to stomach denying cutting-edge treatment because it’s too expensive, like the UK? https://www.theguardian.com/science/2017/dec/20/drug-giants-...

That’s what makes me nervous about socialized medicine in the US. I’m absolutely in favor of universal coverage—a healthcare system that maximizes the health of the average productive person. But I worry that Americans lack the cold realism of Brits, and won’t be able to effectively control costs by denying cost-ineffective treatments.

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