Employees Start to Feel the Squeeze of High-Deductible Health Plans • Hacker News Board

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

#261

Post by mikeash » Fri, May 03, 2019, 9:09 PM UTC

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…

I’m sure they would require you to get routine services if they could.

Car insurance doesn’t cover routine maintenance because they also don’t cover problems that arise from not getting routine maintenance. I’d you neglect oil changes and blow up your engine, they don’t care, they don’t have to pay for it.

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

#262

Post by FireBeyond » Fri, May 03, 2019, 9:09 PM UTC

jdoliner wrote: post #148

LarryDarrell wrote: post #92

Earlier quoted context omitted.

I hate on the ACA as much as the next guy, but the article you linked blames drug overdoses and suicides. For that I would blame the for-profit health care system pushing opioids and the (Great Recession + inadequacy of our mental health care system). To blame that on a law that sought to eliminate preexisting conditions and to establish a baseline as to what a health insurance plan ought to provide seems like a stre…

I was just linking that as a reference for the declining life expectancy. I don't think they even come close to establishing opioid and suicide deaths as the cause, that's just journalistic conjecture. If you look at the number of opioid and suicide related deaths it's very small compared to the total population of the US, so the math just doesn't seem to work out for me. I remember an HN comment a while ago that wor…

Apropos of anything else, as of 2019, you are more likely to die of an opiate overdose (accidental or deliberate) than you are in an MVA. That's staggering.

Of course, not unexpected in a country that has 3% of the world populace but 81% of the world's opiate use.

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

#263

Post by secabeen » Fri, May 03, 2019, 9:12 PM UTC

throwaway34241 wrote: post #252

mieseratte wrote: post #155

Earlier quoted context omitted.

> 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 n…

> 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?

One of the issues (and I like the ACA generally), is that that limit removes an incentive for the insurance companies to control costs and the 20% markup becomes a floor, not a ceiling. If they get 20% of revenue as non-medical costs, and they want to increase their profit, the best way to do that is to allow medical costs to increase. Then their 20% is larger because the pie of costs is larger.

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

#264

Post by Matticus_Rex » Fri, May 03, 2019, 9:13 PM UTC

craftyguy wrote: post #242

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…

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.

If only there were a way to measure that

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

#265

Post by mikeash » Fri, May 03, 2019, 9:14 PM UTC

CydeWeys wrote: post #243

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…

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 an…

Before Obamacare, insurance plans had lifetime limits. So even if you got a really expensive treatment approved, it would potentially push you over your lifetime limit and leave you with no coverage at all.

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

#266

Post by yardie » Fri, May 03, 2019, 9:14 PM UTC

civility wrote: post #137

bliblah wrote: post #67

Earlier quoted context omitted.

>> just needs to be actually thought through, It's impossible because you both political parties want exclusively mutual results You can't have cheap insurance without making it mandatory since only the sick will get it You can't have easily accessible insurance without forcing healthcare companies to comply with new regulations forcing them to increase costs You can't have good insurance if you aren't willing to pay…

> You cant lower costs in the US without having a more aggressive regulatory body which 50% of political bodies strongly oppose alongside lobbying efforts Here is the fundamental problem from my point of view. Compare human medical costs to veterinary costs. Yes, people expect a slightly higher standard for themselves than they do their animals, but you can get a major knee surgery for your dog for a small fraction o…

> you can get a major knee surgery for your dog for a small fraction of what they charge for humans.

I mean you can't really compare vet bills to surgery bills. Veterinarians have actual price constraints where the owner is willing to put their foot down once it gets beyond a certain point. They love their pets but they aren't willing to go financially insolvent for them.

No such constraint exists for American healthcare. You pay what they tell you until you are destitute and on Medicaid.

> by mandating they advertise true prices

I think most Americans want this to be the solution and it still won't work unless there is pressure on the entire system. Doctors, hospitals, surgery theaters, radiology, and diagnostics have such complex billing that even if you could price compare are you even capable of understanding what those options do?

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

#267

Post by lowercased » Fri, May 03, 2019, 9:17 PM UTC

pintxo wrote: post #255

pdonis wrote: post #250

Earlier quoted context omitted.

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.

they do the same thing in the US too, to varying degrees.

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

#268

Post by mikeash » Fri, May 03, 2019, 9:19 PM UTC

Domenic_S wrote: post #251

newsoul2019 wrote: post #158

Earlier quoted context omitted.

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…

They’re describing health insurance, except for the part where you pay what you can and get what you need and people are all in one pool.

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

#269

Post by EvanAnderson » Fri, May 03, 2019, 9:20 PM UTC

jetrink wrote: post #30

tptacek wrote: post #4

Isn't the point of an HDHP that you're supposed to set up an HSA to go with it? Premiums for HDHPs are significantly lower than for normal health plans; the idea is that you're supposed to use the premium savings to fund the HSA, which is then money that carries over year over year, right?

I'm self-employed, so I get insurance through the marketplace. The plans that qualify for use with an HSA are more expensive than plans that are not legally HDHPs, but just happen to have a $6000 deductible and $7900 max out of pocket. They are so much more expensive, in fact, that they completely negate the tax advantages (which are significant.) As a result, I contribute to a basic savings account instead of an HSA…

This has been my experience, too. I've been self-employed since 2004 and had an HDHP w/ an HSA prior to the ACA. The premiums from 2004 to 2014 were lower than equivalent non-HDHP's, but post-ACA (we dumped our pre-ACA plan because I had a pre-existing condition that was not covered in our pre-ACA plan) we've seen equal or high premiums for HSA-capable HDHP's to non-HSA-capable plans.

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

#270

Post by malandrew » Fri, May 03, 2019, 9:22 PM UTC

exelius wrote: post #231

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…

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 m…

> but at a high cost to society without much societal benefit.

People are employed and knowledge is gained. That may be $500,000 treatment for 6 months now, but that treatment may be improved and democratized until it evolves into something that is $50,000 for 6 years.