Rising health insurance deductibles fuel middle-class anger and resentment • Hacker News Board

Re: Rising health insurance deductibles fuel middle-class anger and resentment

#51

Post by mywittyname » Thu, Jul 18, 2019, 1:32 PM UTC

mAEStro-paNDa wrote: post #32

I used to work at a med school, and often I would be in the classroom. Once the Dean gave a presentation over the true cost of healthcare in the US. What was his final conclusion to the class? No one knows the true cost of healthcare. It's nonsensical. The situation with healthcare in the US has been beyond ridiculous for quite some time. Often the conversation centers around those without insurance, but being under-…

My partner works at a hospital billing insurance companies and nobody there can even figure out what prices are. They can't optimize their work based on price because a $700k bill might end up bringing in $30k in revenue, while a $45k bill might bring in $35k.

Hospitals basically need an army of lawyers to renegotiate costs on a per-patient basis. Talk about efficiency!

Medicare/Medicaid literally keep most hospitals afloat. They are basically the only insurer who is fair and pays consistently.

Re: Rising health insurance deductibles fuel middle-class anger and resentment

#52

Post by mywittyname » Thu, Jul 18, 2019, 1:36 PM UTC

larrik wrote: post #24

pmorici wrote: post #11

All I know is that in 2013 I was able to get insurance in the private market to cover myself. It was ~$80 a month and the deductible was $2000. Now, there is only one company left in my state that will even offer plans in the private market. The closest plan to what I used to have has gone up ~6x in price and the deductible has tripled. The prices started going up immediately after the ACA came into being I think the…

The prices started going up as soon as ACA was being voted on, "just in case". Edit: It seems my comment is being interpeted as for or against ACA, when the point was really that insurance companies will raise prices over every potential regulation change.

The ACA was in response to 20 years of super-inflationary price increases and the inability of huge swaths of people to even afford healthcare.

Re: Rising health insurance deductibles fuel middle-class anger and resentment

#53

Post by mises » Thu, Jul 18, 2019, 1:50 PM UTC

The problem here is that years of abusing "insurance" - billing regular prescriptions to something intended to be used for catastrophic events - have led to prices being raised without the consumer feeling the net effect, right away. It was a band-aid, nothing more.

There was an article a few months back about an indian gentleman who was essentially industrializing health-care. This is what we need. Maybe some one who does routine carpal-tunnel surgery does not need a full MD? Some how, medicine was one of the few industries which never industrialized. By doing this, we can go back to looking at insurance the right way: something for catastrophic events. Regular health care is expensive, and no system can realistically have the balance of its members taking out more than they put in long-term.

Re: Rising health insurance deductibles fuel middle-class anger and resentment

#54

Post by volkl48 » Thu, Jul 18, 2019, 1:53 PM UTC

rb808 wrote: post #5

I have a high deducible plan and think its a good idea that everyone gets one. It means you're much more aware of costs and much more careful. One of the reasons the total US healthcare bill is so high is that many/most people get lots of unnecessary tests, lots of marginally useful procedures and lots of expensive emergency work instead of trying to be healthy in the first place. Finally having people feel the sting…

As with many things, a high deductible plan makes sense in theory and does not work very well for the average person in reality.

To walk through some but by no means all of the problems:

- The average person is bad with money. Always has been, likely always will be. A high deductible plan only "works" if you hold onto the money you would have spent on higher upfront premiums so that you can directly pay for care if you turn out to need it. The problem is, the average person lives paycheck to paycheck, saw the extra money in their bank account, and spent it. Now they're reluctant to get any care, even when necessary, because they don't have the money and it looks like a new expense. Which leads to worse health outcomes, and more things being put off until they become expensive emergencies.

- Few people have the medical knowledge to determine what tests are unnecessary or what procedures are marginally useful. Most people are not in the habit of challenging people who are the experts in the field, who they explicitly went to see for their knowledge.

- Even fewer people have that medical knowledge and have the time and energy to spend on navigating near-incomprehensible bureaucracies to actually compare prices, quality of care, etc to try to make an optimal choice.

-----------------

The solution to expensive healthcare should not be that everyone needs to become financially disciplined, a domain expert in healthcare willing to challenge authority figures, and to waste large amounts of their own time attempting to provider-shop in a system unlikely to ever make that a simple process.

I have a HDHP. I save a bunch of money with it, and unlike the average person, I'm in a position where I can do all those things. I get a relatively optimal outcome, although it still wastes a bunch of my time to navigate.

While I personally benefit, I strongly feel that HDHP's are not proving to be a net-positive for the system or society.

Here's a recent Bloomberg article basically going through a bunch of those unintended consequences: https://www.bloomberg.com/news/features/2018-06-26/sky-high-...

Re: Rising health insurance deductibles fuel middle-class anger and resentment

#55

Post by mises » Thu, Jul 18, 2019, 1:53 PM UTC

p_roz wrote: post #15

Health insurance should be decoupled from employment. Its tax advantaged treatment causes distortions in the costs and coverage offered. I’d rather see people get more of their compensation in cash rather than a health insurance benefit. It would especially help poorer workers who would have more flexibility and choice.

More employers ought to do this, for sure. If I'm a young, healthy, twenty-six-year-old man, I almost certainly don't need medical care. If I've got a good job, I can essentially self-insure. I might want to keep actual insurance, i.e. high-deductible protection for catastrophic events, but nothing more.

Re: Rising health insurance deductibles fuel middle-class anger and resentment

#56

Post by mises » Thu, Jul 18, 2019, 1:55 PM UTC

mAEStro-paNDa wrote: post #32

I used to work at a med school, and often I would be in the classroom. Once the Dean gave a presentation over the true cost of healthcare in the US. What was his final conclusion to the class? No one knows the true cost of healthcare. It's nonsensical. The situation with healthcare in the US has been beyond ridiculous for quite some time. Often the conversation centers around those without insurance, but being under-…

> single-payer system

Why could I not buy my own insurance? Or why can't I self-insure? If I want to pay for the best, I ought to be able to buy it (again, if I will pay).

There's a difference between actual single-payer (in which there is a single entity which pays, the government) and a government health-care plan. For which are you advocating?

Re: Rising health insurance deductibles fuel middle-class anger and resentment

#57

Post by koolba » Thu, Jul 18, 2019, 1:55 PM UTC

mywittyname wrote: post #31

koolba wrote: post #21

Earlier quoted context omitted.

That’s not enough. What the people should do is demand that corporate health insurance be banned and demand uniform/transparent pricing. (Removing the corporate tax deduction and adding a personal one would have the same effect) That’d lower the cost of the average policy as their would be an influx of (on average) healthier people to the market for insurance.

We need to eliminate tax deductions as well. They distort behavior yet only benefit the wealthy. Families making under $50k aren't paying much in federal taxes as it is. The federal tax bill for a family of 4 making $50k/yr is $2,739. Cutting their tax bill in half gives them back a little over $100/mo.

The individual tax deduction is meant to be a temporary bait and switch. A full top line individual deduction of health insurance premium would allow corporations to shift their current contributions to their employees with no net tax consequence (income paid is deductible for the corporation and the premium would be for the individual).

Once that’s in place the next step would be making the general populace aware that the majority of the deductions, at higher tax brackets mind you, are going to the top. That would give the political capital to eliminating the “fat cat insurance deductions” and gradually get us to sanity.

Re: Rising health insurance deductibles fuel middle-class anger and resentment

#58

Post by exabrial » Thu, Jul 18, 2019, 2:02 PM UTC

MichaelApproved wrote: post #43

exabrial wrote: post #39

Earlier quoted context omitted.

Hsa's are pretty simple.... Tax free account to pay for health expenses. If we all _exclusively_ had them, I think our insurance rates would drop significantly. Not only would purple be concerned about the price of procedures, but would actively keep a eye on their usage.

It's impossible to properly "keep an eye" on the price of procedures. Call your dermatologist and ask how much it would cost to get a mole removed and checked for cancer. Now, 2 hours later, if they even have you a price, tell me if that's reasonable or overpriced. What are you basing that judgement on?

Apologies, I wasn't referring to that. I was referring to it's easy to keep an eye on the "total cost you've spent" using an HSA, because it's your money in your account.

Re: Rising health insurance deductibles fuel middle-class anger and resentment

#59

Post by stult » Thu, Jul 18, 2019, 2:04 PM UTC

MichaelApproved wrote: post #6

I have $6,500 deductable. It's insane how much work I need to do to get healthcare. The biggest issue is price transparency. To get a price, I need the tax-id of the medical office and the procedure code. Often times the procedure code is unknown because I might have any number of different procedures, depending on what the diagnosis is. So, I take my list of codes to the health insurance company with the tax ID and…

I used to be a lawyer (thankfully have since moved to a more rewarding career). My girlfriend at the time was erroneously billed $2000 for a procedure that the insurance company had pre-approved but later denied the claim for. She had them recorded pre-approving, and they failed to decline her claim within the statutorily specified period anyway so it was a prime facie invalid denial. I had to write several letters, talk on the phone with their legal department for hours, and ultimately get the state insurance commission to initiate an investigation before getting them to back down. It took over 60 hours of work from a qualified attorney to handle a grossly invalid claim denial. Had I charged her at what was then my actual hourly rate, it would have cost $18000 to handle her $2k problem, for which she received no compensation. I honestly don't know how people get healthcare in this country without getting a law degree first.

Re: Rising health insurance deductibles fuel middle-class anger and resentment

#60

Post by linuxftw » Thu, Jul 18, 2019, 2:22 PM UTC

germinalphrase wrote: post #35

linuxftw wrote: post #28

Earlier quoted context omitted.

Literally half the country tried to warn against this exact same thing happening before the ACA passed.

This pattern of exploding healthcare costs didn’t begin with the passage of the ACA (though the ACA is also obviously not the solution). The ACA did increase costs as insurance companies couldn’t suddenly refuse service because they are actually sick (preexisting conditions), but what is our healthcare system doing if it’s NOT treating sick people?

> ACA did increase costs as insurance companies couldn’t suddenly refuse service because they are actually sick

Insurance companies are in business to make a profit. What the ACA did was ensure insurance companies have captive customers. A plan with a $6500 deductible vs pay a fine, nonsense. I should be free to choose between the plan or no fine. If it's all sick people in the plan pool because healthy people opted-out, that's the insurance company's problem, not mine.

Now that the individual mandate is gone, we can watch the deductibles climb ever higher and push people out of insurance.

For many people $6500 might as well be $50k.

I would support a full repeal of ACA and replacement with government payer for all, so long as private insurance is not outlawed and can go back to pre ACA form (I'd like to see more changes, but that's a starting point).