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

#281

Post by danans » Fri, May 03, 2019, 9:42 PM UTC

epicureanideal wrote: post #258

pdonis wrote: post #248

Earlier quoted context omitted.

> 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…

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

This is basically a subscription. But this is also how health insurance already works in part today. A certain portion of your premium is paying for routine doctor's office visits - the insurance company is basically just acting as a payment processor for this portion of your healthcare expenditure. You could separate it from health insurance, but it likely won't make a huge difference in costs or access to care.

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

#282

Post by pdonis » Fri, May 03, 2019, 9:42 PM UTC

epicureanideal wrote: post #258

pdonis wrote: post #248

Earlier quoted context omitted.

> 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…

> Maybe we should have two separate kinds of health insurance?

I agree we should have two different types of "plans". The one for emergencies and rare conditions would be insurance. The other would not. :-)

One key objective of the "other" plan (the one that's not insurance) should be to make the actual costs of services visible to the patients, who are the ones in the best position to assess the value of those services to them. One of the biggest inefficiencies in our current system is that people get all kinds of health care services without any idea of what they actually cost. That means nobody really knows whether those services are worth what they actually cost. That's a recipe for huge inefficiency and high costs, and so it's no surprise that that's what we have.

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

#283

Post by danans » Fri, May 03, 2019, 9:46 PM UTC

mikeash wrote: post #265

CydeWeys wrote: post #243

Earlier quoted context omitted.

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.

To clarify, I think you mean lifetime limit for the insurance company, not you.

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

#284

Post by mikeash » Fri, May 03, 2019, 9:49 PM UTC

danans wrote: post #283

mikeash wrote: post #265

Earlier quoted context omitted.

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.

To clarify, I think you mean lifetime limit for the insurance company, not you.

What do you mean? The limit was on your coverage. Once you exceeded that limit, you had no more coverage.

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

#285

Post by exelius » Fri, May 03, 2019, 9:54 PM UTC

malandrew wrote: post #270

exelius wrote: post #231

Earlier quoted context omitted.

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.

A citizen science model — which is what we de-facto have for anything that isn’t cancer — is more efficient and cost effective.

As it is, if someone finds a new life-saving use for an 80 year old drug, there are suddenly shortages of the old drug while a new, patented analog is sent through clinical trials. See also ketamine and depression.

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

#286

Post by trashface » Fri, May 03, 2019, 9:57 PM UTC

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…

The ACA barely touched employer-based insurance. It definitely did not make things "modestly worse for most people". You are blaming the ACA for problems that existed in the health care system before the law went into effect. Any degradation of care for "most people" is because of crazy year-over-year cost increases that were already happening.

And the people who had pre-existing conditions before the ACA were well and truly screwed. That didn't mean insurance was expensive for them - it meant insurers wouldn't sell them insurance at any price.

My personal anecdote: Pre-ACA, I was denied insurance by Aetna at age 35 because I had "acid reflux" and I had injured my neck in my 20s (even though I had no problems with it at the time). Then all the other insurers denied me, because the first question on any application was, have you ever been denied for health insurance? The annoying thing was the ACA had already been passed, but had not gone into effect yet - so until that happened, I guess it was just business as usual for the insurers.

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

#287

Post by AnthonyMouse » Fri, May 03, 2019, 10:01 PM UTC

WorldMaker wrote: post #245

kristjansson wrote: post #93

Earlier quoted context omitted.

> 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…

> 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.

Almost nothing actually works that way. Walmart doesn't stock exactly the same goods as Target. One of them may be closer to where you live than the other.

Which is why price isn't the only criteria. If the office closest to your home charges $250 and one which is fifty miles away charges $200, you can perfectly well choose to pay the extra $50 for the convenience.

The issue is that when the nearest office decides to charge $1000 and the one fifty miles away is still charging $200, that should maybe change the outcome. But not if you aren't aware of the price difference to begin with.

And this even applies to the beloved family doctor -- there is a limit to the amount of price gouging that a familiar face is worth.

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

#288

Post by andyv » Fri, May 03, 2019, 10:05 PM UTC

briffle wrote: post #126

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.

I find it odd that some executive gets to pick which 401k and health insurance plans you get, and that you must pick from their few choices that allow you to have. I can see why the providers love it, they can target all their advertising, marketing, etc, at a few key people at large employers, but not sure how that benefits the average worker..

I have a work friend who dislikes our company 401k plan. Every year, he rolls the money into another 401k that he likes.

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

#289

Post by andrekandre » Fri, May 03, 2019, 10:06 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…

> 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.

this, in my opinion, points out a significant flaw in the rush to privatize just about everything:

there are many many “markets” that are either under-served or not served at all because the rate of profit would be (a) too low to “justify” or (b)none at all.

jmo but, there has to be a balance between for-profit and basic research that won’t necessarily be able to be monetized to the extent many in industry would want...

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

#290

Post by BurningFrog » Fri, May 03, 2019, 10:06 PM UTC

epicureanideal wrote: post #258

pdonis wrote: post #248

Earlier quoted context omitted.

> 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…

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

But this is not an insurance.

Structuring it as an insurance - as we have done - only makes it a lot more expensive than paying for it out of pocket.