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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

#251

Post by Domenic_S »

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)

> Pay what you can

Surely "what you can" should be relative to both your income and your need. We'd need to supervise the system to make sure people aren't taking advantage or else the whole system goes broke.

> into a common pool

We could also invest the money in the pool to make some extra cash and reduce what people need to pay in, we'd have to have an organization do that too.

> (only as much as you need)

How can we know what people need? We'd have to charge a token amount for office visits and medication so that people aren't frivolous with their medical visits, while perhaps guaranteeing an out of pocket limit in case of extreme illness. We'd also need some kind of system to verify that people are only taking what they need.

I think you just invented health insurance.

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

#252

Post by throwaway34241 »

mieseratte wrote: post #155
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.

> If you're saying the ACA harmed the health care system, strong disagree. The system? No. Corporate welfare is great for "the system." But the consumers? Absolutely harmed! > Again: the cost increases you're talking about were a fact of life before the ACA. I've been working for over a decade now. 100% increases, year-over-year have never been even close to a thing with employer plans I've held. Not even close. Typi…

> The reality is the ACA allows insurance firms to sell obscenely over-priced plans to consumers.

As far as I am aware, the ACA actually introduced limits on how much mark-up health insurance can have, where 80% of the cost must go to actual medical expenses, and administration, marketing, etc must be no more than 20% total. So how is the ACA the cause of insurance mark-up?

I think the actual root of the problem is not mark-up but that health care in the US is quite expensive (and always increasing). The ACA in some cases shifts who pays for it (young healthy people pay more), but it doesn't appear to change much the overall cost. It sucks temporarily for those younger people, but considering they will most likely become older, less-healthy people over time it doesn't seem that unfair overall.

> A sane system would have seen price controls in conjunction with the requirement for insurance.

If you are paying 4x more though, it sounds like the marketplace may be breaking down in your location with a "death spiral", where the price goes up, all the healthier people leave, causing the remaining insurance pool to be even sicker and the price going up even more. The whole purpose of the mandate was to prevent this, but it looks like it's been repealed. Price controls in that situation is hard since the pool is actually expensive to insure, I don't think the government can force the companies to sell at a loss. To reverse it maybe they could re-instate the mandate, or change it to a tax, or add a public option. Or, of course, give up on insuring pre-existing conditions.

> I would happily pay taxes for a fully nationalized system

Keep in mind, there are other countries like Germany and France that have private insurance markets and much cheaper care. I think it is fully possible for the US to implement a nationalized system that does not achieve the cost-effectiveness that we want. The VA system might be an example of how that might go.

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

#253

Post by FireBeyond »

AdmiralAsshat wrote: post #43
rb808 wrote: post #39

I really like the idea of high deductible plans. The idea for me is that insurance shouldn't cover regular costs that most people pay every year. Insurance should just be for unusual events, like car insurance is only used if you have an accident. So now I got a $2k bill from ER for something that wasn't really an emergency. It makes me think carefully about next time this happens where before the cost didn't really…

I'd like to know if there's any empiric data on how many people go to the ER for something that "wasn't really an emergency." Then I'd like to know how many people have died because they didn't go to the ER for something that really was an emergency. My guess would be that the latter greatly outweighs the former. And I'd follow up that guess with a wager that a large percentage of those people failed to go to the ER…

Encouraged in part by a system where finding "Urgent Care" outside of 9-5 Monday to Friday can be very difficult to impossible in many locations.

Only thing worse is dentistry. Following a bad toothache, I walked through the directory. Not a single dentist in my entire County (quarter of a million people) was open on a Friday, let alone the weekend.

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

#254

Post by WorldMaker »

defen wrote: post #77
tptacek wrote: post #34

Earlier quoted context omitted.

Ok, so then, the nut of this story is that employers are adopting HDHPs as a way of reducing their own costs, but not passing the savings to employees, which defeats the purpose of HDHPs and just amounts to screwing employees over?

I'm not sure - since I have either option, I don't feel screwed over, but if an HDHP were the only option I would definitely expect to see an increase in take-home pay.

In a decade of employment I've not had an employer offer a plan that wasn't an HDHP. It seems to be somewhat regional, but in my part of the country the last plans that weren't HDHPs were phased out in the late 2000s and seem unlikely to ever return.

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

#255

Post by pintxo »

pdonis wrote: post #250
pintxo wrote: post #247

Earlier quoted context omitted.

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?

No. But insurances are (to different degrees) heavily promoting checkups and health/fitness improvement programs.

Some are even handing out coupons and benefits for those joining fitness studies or sports clubs etc.

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

#256

Post by clarkmoody »

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.

Employer-provided healthcare is an aberration created by government interference in the market.

> Employer-provided health insurance has its origin in a tax policy passed in 1943, which made insurance provided by employers tax free. At the time the United States was engaged in World War II and had enacted wage and price controls, preventing employers from competing for scarce labor using the normal mechanism of offering a higher salary. Instead, businesses used the availability of newly tax-subsidized healthcare as a means of differentiating themselves.

> The tax advantages were made even more attractive and fully codified in the 1954 Internal Revenue Code. Over the next few decades, the government's subsidization of employer-provided health insurance lead to the dominance of that model of healthcare delivery...[1]

So steps that got us here:

1. Enter into WWII

2. Enact price & wage controls

3. Create tax loophole for employer-provided plans

4. Enshrine loophole into the tax code

These are not market phenomena, since government intervention got us here.

[1] https://mises.org/library/whats-really-wrong-healthcare-indu...

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

#257

Post by FireBeyond »

conorh wrote: post #41
rb808 wrote: post #39

I really like the idea of high deductible plans. The idea for me is that insurance shouldn't cover regular costs that most people pay every year. Insurance should just be for unusual events, like car insurance is only used if you have an accident. So now I got a $2k bill from ER for something that wasn't really an emergency. It makes me think carefully about next time this happens where before the cost didn't really…

I like it too, except that my (bronze level in the marketplace) high deductible plan is ~$1300 a month for my family, that is not sustainable. A recent ER visit with 1 night stay cost us about 8k out of pocket, the family deductible for the plan is $13k a year.

Be glad that "recent" wasn't in December, prior to the deductible reset.

Fun fact - my company (who sells Health Benefits Management software) added functionality so an insurer could do a "rolling window" for deductible / out of pocket management, i.e. "In any given 12 month period, your costs will not exceed $x" (where given unfortunate timing, your out of pocket could actually be 2x).

Except it was less profitable to the insurers, so no-one was interested. But spun as "will be too complicated for consumers".

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

#258

Post by epicureanideal »

pdonis wrote: post #248
ericpauley wrote: post #239

Earlier quoted context omitted.

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…

Maybe we should have two separate kinds of health insurance?

One for true emergencies (like car accidents), and rare life threatening diseases (like cancer before 60).

Another for routine things, but as others have said, routine things shouldn't be so expensive.

I like the idea of structuring it like a term life insurance policy. If you die, you get money, and in some policies you even get some percentage before you die to have fun.

So, if you get cancer or whatever, perhaps you'd have a pool of funds available to you to deal with the disease, and you can use that money how you want, and perhaps even keep the remainder (or a portion of it) to incentivize keeping cost down.

Also, it would make sense for the pool of funds available to someone to be based on remaining years. If you get cancer when you 20 it makes sense to spend a million dollars trying to cure that. If you're 90, maybe it makes sense to treat it but not as aggressively or in as costly of ways.

From the perspective of building a society that you would be willing to be in, assuming you were randomly born into that society without knowing to what parents, I still think many people would agree they'd rather spend heavily on younger people than older.

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

#259

Post by pintxo »

pdonis wrote: post #248
ericpauley wrote: post #239

Earlier quoted context omitted.

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…

They (auto insurances) provide reduces rates for e.g. driver trainings.

The technical aspect for cars (in Germany) is handled by the TÜV (mandatory bi-annually technical review).

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

#260

Post by evgeniysharapov »

bradfa wrote: post #98
defen wrote: post #85

Earlier quoted context omitted.

> For example, I enroll my family in my employer's HDHP. The total premiums from our plan is about $19k this year (employer pays about $14k, I pay about $5k). For this, we have $4k deductible and an $8k max out of pocket coverage. Posts like this really emphasize to me how broken healthcare in America is. This is a fairly standard setup and yet you're paying $23,000 per year before you get anything from your insuranc…

Regarding price negotiation, my wife and I have asked multiple doctors, nurses, and billing departments to tell us how much a given service we have received will cost. Both before the service and after the service. We've even called the insurance company with the billing codes from the doctor's office to get quotes. NO HUMANS CAN TELL US HOW MUCH ANYTHING COSTS! We are continually told that we have to wait for the in…

When I was shopping around I was told by hospital rep, that they can't tell me the price, because of a) they don't know until they talk to insurance company, b) EMTALA prohibits that.
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