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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

#241

Post by gumby »

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…

Of course it does, by rejecting many people from the medical system.

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

#242

Post by craftyguy »

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…

Preventative measures (e.g. annual physical) can be seen as a form of insurable risk management. It's arguably much cheaper to treat something if it is discovered early on.

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

#243

Post by CydeWeys »

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…

Insurers deny expensive or cutting-edge treatments in the US all the time! You don't have to look hard to find sob story after sob story.

And it makes sense. If a treatment is super-expensive and unlikely to be effective anyway, and that money could be put to better use to help more other people ... It's like how someone who smokes isn't going to get a lung transplant; there's too many others that need transplants and not enough lungs to go around, so give the lungs to the people who will benefit the most from them (generally, people who are young and otherwise healthy). There aren't infinite resources in this world, so in the cases where scarcity comes into play, they should be doled out in the way that creates the greatest good.

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

#244

Post by logfromblammo »

newsoul2019 wrote: post #158
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…

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)

Or turn it around and make it equally burdensome to both insurer and patient. If you acquire a malady while insured by a particular company, all medical expenses that are tied to that diagnosis must be forevermore paid by that insurer, even after the policy lapses, is cancelled, or the patient switches insurers.

If that sounds unfair to an insurer, that's great--now they know how we feel about it.

Insurers want to deny pre-existing conditions because they don't want to add already-sick people to their risk pool. They wouldn't have to, if the previous insurer was still on the hook for that diagnosis. But they'd never agree to that, because it exposes them to some of the same insolvency risk due to medical bankruptcy that some patients have to face.

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

#245

Post by WorldMaker »

kristjansson wrote: post #93
AnthonyMouse wrote: post #49

Earlier quoted context omitted.

> The only "advantage" is that companies have to pay smaller premiums and employees are greatly discouraged from getting care due to high costs. In principle the advantage is that employees are greatly discouraged from paying too much for care. If the insurance pays for everything then what do you care if your doctor is charging $1000 for a physical instead of $50? If you're paying out of pocket, now you care. The pr…

> price transparency And even list prices themselves are typically starting points for negotiations when a provider is dealing with a large payor whereas an unwell individual (y'know, one who is about to spend a lot of money on healthcare) is not in a great position to bargain with her caregivers, and so is forced to negotiate after the fact, from an artificially inflated starting point, under the guise of bill reduc…

A lot of the issues with pushing price negotiation to the individual also seem to be assuming (or worse, lying about) that most medical professionals, procedures, facilities, et al are entirely fungible. Even if individuals had full price transparency, that doesn't change the fact that certain facilities will always be closer to home, certain procedures inescapable, certain medical professionals decades or life-long relationships to build, etc. Medical services aren't just interchangeable factory goods on a retail store shelf that you can easily pick based on price alone and then slot it right into its widget shaped hole, and never will be.

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

#246

Post by lotsofpulp »

dsfyu404ed wrote: post #180
lotsofpulp wrote: post #104

Earlier quoted context omitted.

That doesn’t make sense. If you spend a lot on healthcare, then why would you want to spend it out of pocket from HSA instead of letting insurer pick it up with a non HDHP?

You only spend out of pocket until the various out of pocket limits kick in.

There is only one out of pocket limit:

https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...

Healthcare costs whatever it costs, no matter what the premium / deductible is. The more of it that is used, the more someone has to pay, and you can be sure the insurance company is going to adjust the premiums or deductible or coinsurance/copay to make sure it's not them (in the long run).

The HSA/HDHP option just lets you gamble that you won't need enough medical care in the year to offset the investment and tax gains of contributing to an HSA. And if you're lucky, you'll make it all the way to Medicare eligibility. Although I'm pretty sure we'll see Medicare start being means tested in the next decade.

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

#247

Post by pintxo »

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…

I might be mistaken, but here (Germany), regular checkups are paid by the insurance on purpose.

The alternative being people not doing the checkups and thereby delaying diagnosis until treatment get‘s really expensive as things get life threatening.

In the end insurance has an interest in people taking regular checkups resulting in early (cheap) action.

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

#248

Post by pdonis »

ericpauley wrote: post #239
pdonis wrote: post #230

Earlier quoted context omitted.

> 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.

> 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

But current plans don't require you to get routine services like an annual physical; they just cover them if you get them. That doesn't make sense if the insurer's incentives that you describe are driving the plan.

Also, these incentives don't seem to be operating in other insurance markets. For example, auto insurance doesn't cover routine maintenance like oil changes or tire rotation.

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

#249

Post by brazzledazzle »

sithlord wrote: post #57
tptacek wrote: post #38

Earlier quoted context omitted.

I'm not seeing the connection to the ACA in your argument. If your argument is that the ACA raised the price of health insurance, that's incorrect: health insurance premiums had been skyrocketing prior to the ACA (that crisis was what generated the political capital to pass the bill), and the ACA in fact reduced the rate of growth in health care costs.

In my previous career, I was an accountant, and I worked for a health insurance company, you are straight up uniformed if you do not think that ACA raised the the cost of insurance. With that said, as a type 1 diabetic, without ACA it would be impossible for me to get insurance outside of employment, so i think there is some good in it, just needs to be actually thought through, unlike what the administration did tha…

You're laying the blame at the administration's feet but you're ignoring the complete shit show in the legislature that resulted in what we have today. They compromised and compromised and finally surrendered major concessions to someone in their own party to get it passed. I'm shocked it did any good at all.

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

#250

Post by pdonis »

pintxo wrote: post #247
pdonis wrote: post #230

Earlier quoted context omitted.

> 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…

I might be mistaken, but here (Germany), regular checkups are paid by the insurance on purpose. The alternative being people not doing the checkups and thereby delaying diagnosis until treatment get‘s really expensive as things get life threatening. In the end insurance has an interest in people taking regular checkups resulting in early (cheap) action.

Are people required by the insurance companies to get regular checkups?
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