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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

#231

Post by exelius »

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…

I have a feeling that without the US market capable of paying a hundred thousand dollars a patient, many of those cost-ineffective treatments never get developed. People could still pay for them out of pocket, but without the guarantee of insurance payments the drug companies likely won’t take the risk.

And I don’t think that’s necessarily a bad thing — if a drug costs $500,000 and keeps my cancer at bay for 6 more months, it provides a high personal benefit from my selfish point of view; but at a high cost to society without much societal benefit. I think you’re right that Americans do lack the realism, but it may become easier if those treatments aren’t developed in the first place.

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

#232

Post by FireBeyond »

creato wrote: post #217
refurb wrote: post #125

Earlier quoted context omitted.

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.

And now we have the worst of both worlds:

Those patients have no coverage so get Emergency treatment for acute symptoms of their issues that rarely fix the underlying problem, and beyond that we also tell them to go fuck themselves.

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

#233

Post by rayiner »

FireBeyond wrote: post #225
rayiner wrote: post #220

Earlier quoted context omitted.

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 ar…

The very first part of the article explains how the NHS denied coverage for certain breast cancer drugs because it was too expensive. My concern is that the Americans won’t be willing to do that. Here, you see all these articles talking about how terrible it is that families went bankrupt going out of pocket after they hit a $1 million cap. The UK wouldn’t have paid for that treatment in the first place.

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

#234

Post by mrosett »

lotsofpulp wrote: post #130
mrosett wrote: post #11

Earlier quoted context omitted.

HSAs aren't use it or lose it. That's FSAs.

tathougies was referring to the difference in monthly health insurance premiums. I don't see what their comment has to do with Flexible Savings Accounts.

I think I may have responded to the wrong comment here. Someone else was saying that HSAs are use-it-or-lose-it.

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

#235

Post by gamblor956 »

snowwrestler wrote: post #191
frenchman_in_ny wrote: post #160

Earlier quoted context omitted.

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?

Unless her employer's insurance plan excluded her based on the pre-existing condition of being pregnant. (which it certainly could have)

The point of trying to get on an employer's insurance plans were that people were not excluded for pre-existing conditions because the employer plans were less selective (and also correspondingly more expensive, though the employer contributions hid the additional expense from the employees).

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

#236

Post by yardie »

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…

> would the US be able to stomach denying cutting-edge treatment because it’s too expensive

No, we're much better off denying basic ass treatments because there isn't enough money in it.

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

#237

Post by mrosett »

FireBeyond wrote: post #227
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,…

My sense is that your experience is becoming more and more common. As far as I can tell, co-pays, deductibles, etc have been going up dramatically over the last few years (as the original article points out.)

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

#238

Post by FireBeyond »

WalterSear wrote: post #144
mrosett wrote: post #51

Earlier quoted context omitted.

That's just not how it worked with employer insurance. Perhaps they could drop your whole company, but the insurer couldn't unilaterally cancel a single employee's plan.

There were plenty of cases where they would raise an employer's premiums and let them know why, and sick people lost their jobs and their insurance.

Witness all sorts of horrible behavior, like employers saying "Sorry, all, no raises this year, because one of your coworkers was using so much of our health insurance pool that they raised our rates!"

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

#239

Post by ericpauley »

pdonis wrote: post #230
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…

While this may make sense from the perspective of why people get insurance (to mitigate a catastrophic loss), it doesn't consider the insurer's incentives. No insurance company will want to underwrite a plan that doesn't bundle routine services, since those clearly reduce risk of complications down the road. A yearly checkup is cheap compared to missing a disease and letting it get worse.

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

#240

Post by FireBeyond »

fzeroracer wrote: post #139
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…

My family went bankrupt because the insurance companies decided my mother having a stroke and falling down the stairs constituted a pre-existing condition. I don't think people understand how pervasive the usage of pre-existing condition bullshit was used to deny payment.

Oh yes. One of my "favorite" stories of this was:

"You didn't know you had X. It had never been diagnosed. But looking at your history, your treatment for 'unknown ailments' and such were actually symptoms of X, in other words you had X, though you didn't know it. And when you signed up for insurance, you 'failed to disclose' this condition [that you didn't know you had], therefore, we are voiding your coverage effective immediately [and should consider yourself lucky if we don't try to 'recover costs'...]".

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