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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

#221

Post by iheartpotatoes »

_bxg1 wrote: post #213

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 ass…

Yet here we are. Remember when Obama fought to have healthcare prices made transparent so that we could shop for the cheapest medical treatment, and that was beaten back severely by the lobby? The compromises the ACA made to bend over backward for for-profit insurance companies were an example of how much power the lobby has. I think if we've learned anything is that we need to go all in on single payer and completely remove for-profit insurance, IMHO, because of exactly what you're saying about the free market: it doesn't work for certain things (if anything, really): military, education, healthcare all the three classic failures of the freemarket. I think this is why all the dems are embracing Healthcare for All: everyone is getting screwed by healthcare except the 1%.

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

#222

Post by snowwrestler »

loeg wrote: post #111
kasey_junk wrote: post #53

Earlier quoted context omitted.

There is no requirement for your employer to provide the HSA. Frequently the employer can get better deals on the HSA than you can individually (like no waived maintenance fees and the like) but you can for sure open your own. In fact once you have enough money in there that you are moving out of liquid investments then you definitely want to shop around for HSA much like you would for an investment account.

Can you actually fund a non-employer HSA with tax-deductible funds, or is that a benefit that only applies to payroll HSA contributions? If not, a lot of the benefit of an employer HSA disappears. (FWIW, I have an HDHP, employer HSA, and an individual HSA that I roll my employer funds to annually for lower-fee investing.)

Where do you have your individual HSA? I have an employer-provided one and I'm looking for a place to move it.

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

#223

Post by drinane »

This is the point of high-deductable... to cast more spend on the average healthcare consumer. Also to make them price sensitive. Wellness programs are designed around making unhealthy people pay more and not trigger any of the non-discrimination issues as well. Single payer is best model proven at scale in modern countries, but it probably will take a couple decades of watching loved ones not get care before it escalates to action.

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

#224

Post by iheartpotatoes »

lotsofpulp wrote: post #81
kxyvr wrote: post #70

For those of us who are self-employed, I'll mention that low or no deductible health plans may provide better value. When they sort of work, health deductible health plans are nice because: (1) monthly premiums are low and (2) they give access to a health savings account (HSA) where some amount of money can be stored pre-tax and then used for health related expenses. Of course, none of this saves someone that gets ha…

The tax savings on the difference in premium between high deductible health plans and low deductible health plans is probably $2k at most ($6k in extra premiums @30% tax rate). That’s for single coverage, but even for family total year tax savings can’t be more than $5k. In either case, triple tax advantage of HSA is far more, especially due to compound growth. If you have the cash to be able to deal with $10k of med…

Have you tried an HSA? What are the caveats on yours? Does the money roll over? Are there limits on how much you can put it? Does the bank that owns your HSA invest it? HSA's look like they were designed to save people money, but they are really just another way for banks to get more capital to invest, which is why there are so many caveats on them. I think it is abhorrent that an HSA even has to exist. An easier sol'n would be to allow no minimum limit on tax deductions, it just makes more paperwork for people. But I think HSAs are a bandaid to a broken system.

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

#225

Post by FireBeyond »

rayiner wrote: post #220
FireBeyond wrote: post #214

Earlier quoted context omitted.

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 realis…

Well, that article talks about blaming Big Pharma for the costs that make it expensive, not the National Health Service.

With the big pool comes big leverage. The NHS effectively said "We're not paying that much", and the pharmaceutical companies decided they'd rather be paid something. Because if someone is not getting treatment, then they're not getting those drugs.

Medicare in the US does this. "This is what we are paying for this drug".

The issue isn't so much this. It's that drug industry lobbies in the US will have far more sway over the politics of this than they would in the UK (or Canada, or Australia, or...).

I definitely don't claim to be an expert on these things. But I have lived in the UK with the NHS, in Australia with its medical system, and now in the US. In addition to that, I've worked as a healthcare provider, and for a Health Benefits Management software company, so I'd at least like to think I have something of a varied perspective.

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

#226

Post by _bxg1 »

iheartpotatoes wrote: post #221
_bxg1 wrote: post #213

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 ass…

Yet here we are. Remember when Obama fought to have healthcare prices made transparent so that we could shop for the cheapest medical treatment, and that was beaten back severely by the lobby? The compromises the ACA made to bend over backward for for-profit insurance companies were an example of how much power the lobby has. I think if we've learned anything is that we need to go all in on single payer and completel…

I think the free market does a good job of solving problems, just not of deciding which ones are worth solving. The military follows a hybrid model that (mostly) works, where a semi-free market is created and guided exclusively through governmental leverage, theoretically giving the best of both worlds. Utility companies work a similar way, as do (I think) some first-world government-run healthcare systems. I think the ACA was aiming for this type of thing, but was so hamstrung by compromises and by the sheer complexity of the system it was trying to reshape, that it ended up being a pretty mixed bag.

Maybe in the case of American healthcare, the current state of things is just such a horrible rat's nest of problems that we really do need to burn it all down and start over.

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

#227

Post by FireBeyond »

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…

That's excellent, and really contributed to your quality of life.

I on the other hand had "excellent" employer-provided healthcare. But when a routine kidney stone (my first) ended up having (pre-existing, not as a result of procedures) infection and I had three procedures for it, two in the OR, the bill ended up being the best part of $100,000, which I had to come up with co-pays and others to the tune of nearly $8,000.

For a kidney stone. Something that (touch wood) I might not have again, but could also have dozens through my life.

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

#228

Post by loeg »

snowwrestler wrote: post #222
loeg wrote: post #111

Earlier quoted context omitted.

Can you actually fund a non-employer HSA with tax-deductible funds, or is that a benefit that only applies to payroll HSA contributions? If not, a lot of the benefit of an employer HSA disappears. (FWIW, I have an HDHP, employer HSA, and an individual HSA that I roll my employer funds to annually for lower-fee investing.)

Where do you have your individual HSA? I have an employer-provided one and I'm looking for a place to move it.

HSA Authority (part of Old National Bank). Last time I ran the numbers, the break-even point on annual expenses vs some other options was about $10k in HSA balance — where smaller balances would pay more at HSAA than some other provider(s). But they cost less than other providers for larger balances (again, last time I checked).

https://www.oldnational.com/thehsaauthority

And for comparison, https://thehsareportcard.com/hsa-authority / https://thehsareportcard.com/the-top-10-investor-hsas-1 . The landscape may have shifted since the last time I did my research.

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

#229

Post by JMTQp8lwXL »

ComputerGuru wrote: post #153
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…

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

Your employer could fire you, though, if you all of a sudden developed an expensive medical condition. HIPAA would say that's illegal to do, but it'd be incredibly difficult to prove that was the reason you were fired.

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

#230

Post by pdonis »

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…

> Healthcare is best managed as a risk pool.

No, health insurance is best managed as a risk pool, which, as you say, should obviously be everyone.

But much of health care is not health insurance because it doesn't deal with insurable risks. Your need to get an annual physical isn't an insurable risk. Neither is a one-time appointment with a doctor to see if your headache and runny nose is just a cold or an infection that requires antibiotics. The first isn't insurable because it's a predictable recurring cost; the second isn't because it's a routine service that shouldn't be so expensive that you can't pay it out of pocket.

Health insurance should be focused on the things that are insurable risks: emergency care, hospitalization, etc. Things that aren't insurable risks, like the above, should be handled differently. But our health care system insists on treating these very different things the same, which of course is going to lead to huge inefficiencies and high costs.

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