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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

#341

Post by eftychis »

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…

Checkups and preventative care are not there for fun. They save money as a whole and in the long run, as other commenters also note.

Imagine everyone was disincentivized from doing a cancer-related checkup, get vaccinated, or check if they have a cold, the flu, or something worse. It is better to spend x now than deal with a crisis (either individual or epidemic related) spending orders of magnitude more.

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

#342

Post by vagab0nd »

paxys wrote: post #8

High-deductible health plans were always designed to benefit employers. My company switched us to one with a big PR campaign highlighting how everything would be better (contributions to HSA - free money!). The only "advantage" is that companies have to pay smaller premiums and employees are greatly discouraged from getting care due to high costs. Funny enough, employers are rethinking this now since employees not ge…

Regardless of whether it benefits employers, it makes sense for healthy young people, no? If your health care spending is low, you get free money every paycheck. Also last time I looked at my HSA account, it's both pre-tax contribution and tax-free growth. So you get double tax break.

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

#343

Post by plandis »

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.

That's no different than health insurance companies in the US.

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

#344

Post by refurb »

tptacek wrote: post #318
refurb wrote: post #125

Earlier quoted context omitted.

The increase in costs were most certainly driven in part by the ACA changes. No longer allowed to deny based on pre-existing conditions? Insurers need higher rates to cover those costs. Require a bunch of things be added to mandatory preventive visits? Those have to be paid for as well. That said, I agree the costs would have continued to go up, but to say there is no evidence that the ACA contributed to it is just i…

You are "most certain" about something that empirical data refutes. Health care costs grew more slowly after the ACA than before it and, in particular, at no point subsequent to the passage of the ACA have health costs grown more than they did during the Bush era. There are all sorts of things that should have (and perhaps even did) impact prices after the ACA. Not just coverage requirements (which, again: most emplo…

I think we’re arguing different things.

Sure, costs went up less after ACA.

However, the ACA directly added costs to insurance that weren’t there previously.

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

#345

Post by tptacek »

pg_bot wrote: post #339
tptacek wrote: post #322

Earlier quoted context omitted.

The numbers here are quite helpful. The parentheticals are harder to understand and, for that matter, so is "higher healthcare costs due to war" (we have a nationalized health care system for war veterans).

I wouldn't expect it to be clear unless you've studied the area for awhile but all of those are external shocks to the marketplace. Healthcare expenses increase during wartime since you have to treat newly injured veterans. That statement basically can be interpreted as "people get injured on battlefields and it costs money to treat them".

First, once again: we have a nationalized health care system for injured veterans. They not only have a separate payer system but also a separate provider system.

Second: I have followed health policy for quite awhile, and it's not clear to me at all what impact you believe your parenthetical callouts had on health costs.

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

#346

Post by tptacek »

refurb wrote: post #344
tptacek wrote: post #318

Earlier quoted context omitted.

You are "most certain" about something that empirical data refutes. Health care costs grew more slowly after the ACA than before it and, in particular, at no point subsequent to the passage of the ACA have health costs grown more than they did during the Bush era. There are all sorts of things that should have (and perhaps even did) impact prices after the ACA. Not just coverage requirements (which, again: most emplo…

I think we’re arguing different things. Sure, costs went up less after ACA. However, the ACA directly added costs to insurance that weren’t there previously.

I don't understand this argument. The ACA changed a bunch of things about the health care system. It reduced some costs and increased others. The point is to reduce the total cost (or, in this case, the total rate of increase in health care costs).

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

#347

Post by secabeen »

throwaway34241 wrote: post #280
secabeen wrote: post #263

Earlier quoted context omitted.

> 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 i…

In a healthy, actually competitive market, I think that would work, but there are so few insurance operators in each market, it's really easy for them to quietly collude with each other rather than compete. Additionally, everyone else in the industry wants higher prices and more profit. They are not limited to a 20% cost margin. The insurance companies are supposed to be the downward drivers on price. However, here, it's just easier to not fight the price increases, take your 20% of the increase, and move on, rather than fight hard to push prices down, and gain market share.

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

#348

Post by scarface74 »

FireBeyond wrote: post #225
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…

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…

Medicare in the US does this. "This is what we are paying for this drug".

That is definitely not true. Part of the prescription drug coverage that was added during the Bush administration was that Medicare could not negotiate drug prices.

https://www.politifact.com/wisconsin/statements/2017/jan/17/...

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

#349

Post by exelius »

andrekandre wrote: post #289
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…

> 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 ha…

I’m not necessarily against a for-profit pharmaceutical industry... but I certainly am when the entire cost burden falls on us because the pharmaceutical companies band together to prevent our government from negotiating drug prices at the national level like pretty much every other wealthy nation...

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

#350

Post by exolymph »

mikeash wrote: post #261
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…

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.

Wouldn't you be more likely to get in a crash if your car were in terrible shape?
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