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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

#271

Post by secabeen »

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…

The insurance companies and the AMA were vehemently against Medicare when it was initially proposed. They fight for it now. Given all of the established interests in the medical system, and the amount of money flowing around, any reform that is actually going to make a major difference is going to be one that they strenuously oppose.

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

#272

Post by wjmao88 »

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.

The insurance company can still offer to pay the cost and/or lower premiums for the insured who goes to regular checkups.

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

#273

Post by quattrofan »

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…

It's weird you think that insurance means they don't deny care, I worked on systems back in the 90s in the US that was focused around rationing. The source of the money is irrelevant since ultimately you have to cap spending somewhere as it's not limitless. The NHS generally does a great job in getting bang for the buck, in fact in terms of treatment effectiveness and longevity it's considered the best in the world.

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

#274

Post by klipt »

lamarpye wrote: post #154
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…

Was the ACA the best to address the problem of pre-existing conditions? https://www.theatlantic.com/business/archive/2011/06/why-has... "There were supposed to be millions of people who were uninsurable because of pre-existing conditions. We heard lengthy testimony about their terrible plight. I don't think it's too strong to say that this fear--that you could get sick and no one would insure you, that's right, you,…

> Wouldn't be better to create a special program for people who fall into this category?

Why? The only difference between "people who have already been diagnosed with cancer" and "people who are going to be diagnosed with cancer" is that you know who the first group is. The second group is hidden among the "healthy" people.

But both groups will need the same treatment.

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

#276

Post by roywiggins »

rayiner wrote: post #233
FireBeyond wrote: post #225

Earlier quoted context omitted.

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.

You have an admirable faith the American insurance companies don't do exactly the same thing, with much less oversight.

https://www.nytimes.com/2019/02/27/obituaries/carrie-ann-luc...

> Her family said an antibiotic Lucas needed to treat her symptoms cost about $2,000 and her insurance company denied coverage of the medicine, leading her to take a less-effective drug. Lucas, who was allergic to multiple drugs and antibiotics, had a reaction to that medication, Lee Lucas said.

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

#277

Post by munificent »

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)

> I don't like the entire concept of "pre-existing conditions".

If you have an elective health insurance system where people choose whether or not and when to participate, it implies this restriction.

Say you have private health insurance companies but don't allow them to prohibit members based on pre-existing conditions. Everyone will simply not get health insurance to avoid paying the premiums until the day they need it. That would make health insurance companies completely unviable financially.

This is why Obamacare both eliminated the pre-existing condition restriction and mandated people get health coverage. You can't have one without the other or you get the free-rider problem.

This is another reason why healthcare should just be universal. It doesn't work at all like an actual efficient market product.

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

#278

Post by rb808 »

godshatter wrote: post #194
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 seem to be the only one that thinks this way, but I view health insurance as a plan to cover catastrophic events. I view it kind of like auto insurance. I don't use auto insurance to get my oil changed or to replace the wipers or to add a rack to the roof. So the high deductible plan I get at work is perfect for me because it has a high deductible, yes, but it has a lower overall ceiling. Meaning that if I get in a…

Agreed, the main wrinkle is that buying auto parts is a simple transaction. With my HD plan the provider still bills insurance first who negotiates a rate then sends me the bill which is hugely inefficient.

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

#279

Post by trashface »

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…

This is solvable. Rather than just "deny" treatments, the insurer (public or private) can just pay the customary amount for treating the given disease. The rest is the patient's responsibility.

So rich people can still get the latest $500K insta-cure prostate cancer treatment (and they are paying out of pocket for most of it), and the rest of us make do with surgery/radiation.

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

#280

Post by throwaway34241 »

secabeen wrote: post #263
throwaway34241 wrote: post #252

Earlier quoted context omitted.

> 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…

Presumably they could pass along the savings and increase revenue by expanding their market share, or lose revenue to a company that controls costs. I see your point though, and in a given year it might be easier to increase medical expenses by 5% than to grow market share by the same amount.

One thing I wonder though, is that even without the 20% rule, if the company can get away with raising rates by 5%, wouldn't it make sense for them to do so? If they started with a 20% margin that would increase their profits by a whole 25%, instead of a measly 5% with the cap, so you'd think the incentives would be even stronger. It seems like adequate competition is the most important thing in a for-profit insurance model rather than having a 20% margin rule or not.

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