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Employer health plans are getting pricier and skimpier

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Re: Employer health plans are getting pricier and skimpier

#61

Post by war1025 »

abstractbarista wrote: post #55

Is it possible that it is due to more people becoming insured that are burdensome on the system? I thought it was pretty expected that as you get more of the unhealthy parts of the population into healthcare, costs will rise for everyone else.

My understanding is that the issue is payment is so divorced at this point from services rendered that there is no pressure to lower costs anywhere.

Hospitals pass their costs along to the insurance companies and insurance companies pass those costs along to individuals, and everything that happens in the middle is so convoluted that the average person can't make heads or tails of it to push back.

Re: Employer health plans are getting pricier and skimpier

#62

Post by lotsofpulp »

war1025 wrote: post #57
cascom wrote: post #47

Earlier quoted context omitted.

1 - If my company buys health insurance for me, its tax deductible(pre-tax), if I buy it myself it is after-tax . Now companies are can just gross-up pay, and don't have to compete on healthcare... 2) Pooling remains an issue, but as it stands now, consumers have little to no choice, one would imagine that once a 125m households start shopping for insurance there is going to be competition on price... in most circums…

I believe the pre-tax post-tax thing is actually wrong. The difference is that you pay for the plan with post-tax money until tax season rolls around, when if I remember correctly (from having an individual plan for several years) you get to deduct those costs. So really, it's just the typical American thing of people being terrible at understanding tax codes and adjusting their withholdings correctly.

Source? IRS specifically states:

https://www.irs.gov/taxtopics/tc502

>You may deduct only the amount of your total medical expenses that exceed 7.5% of your adjusted gross income. You figure the amount you're allowed to deduct on Form 1040, Schedule A.

It’s another subsidy for big business in the US. If you work for a small employer that doesn’t offer health insurance, you’re paying with after tax money.

Re: Employer health plans are getting pricier and skimpier

#63

Post by Wohlf »

blahyawnblah wrote: post #16
vkou wrote: post #13

Of course they are, healthcare costs are growing in an unbounded manner, way ahead of inflation.

Why is this? Are there more sick people or just more people?

It's a lot of things, but inefficiencies and needless end of life care are big parts.

Re: Employer health plans are getting pricier and skimpier

#64

Post by tempsy »

mieseratte wrote: post #59
tempsy wrote: post #49

I think another thing about employer-based healthcare that few think about is that if you work for a large company then it is almost certainly self-insured, meaning that you or your employer is paying premiums into a fund that it is managing itself. How crazy is it to think that not only does Apple or Ford or Trader Joe's need to manage it's own business but that it is also hiring actuaries/insurance specialists/cons…

> I'm not sure many people that work at large companies realize that their employer knows every diagnosis, procedure, and prescription you've ever picked up, and actively trying to incentivize you to use as little healthcare as possible. I work for such a company, and it's great. I pay about $30 per month for a plan with a tiny deductible ($2,500), and they offer great wellness perks like weekly classes (yoga, kick-b…

I don’t understand your comment. If the company is large it is likely self-funded, so it is taking on the risk, whether they are doing it in house or hiring a benefits consultant to do it for them.

I didn’t say anything about the quality of a self-funded plan, simply just pointing out that a self-funded plans means your relationship with your company is not merely just a worker but you morph into this insurance risk that they now have to actively manage. I am pointing out how strange it is to ask a company to have to do that, which is unlike any other country in the world.

Re: Employer health plans are getting pricier and skimpier

#65

Post by DaiPlusPlus »

war1025 wrote: post #57
cascom wrote: post #47

Earlier quoted context omitted.

1 - If my company buys health insurance for me, its tax deductible(pre-tax), if I buy it myself it is after-tax . Now companies are can just gross-up pay, and don't have to compete on healthcare... 2) Pooling remains an issue, but as it stands now, consumers have little to no choice, one would imagine that once a 125m households start shopping for insurance there is going to be competition on price... in most circums…

I believe the pre-tax post-tax thing is actually wrong. The difference is that you pay for the plan with post-tax money until tax season rolls around, when if I remember correctly (from having an individual plan for several years) you get to deduct those costs. So really, it's just the typical American thing of people being terrible at understanding tax codes and adjusting their withholdings correctly.

Health insurance premiums are only fully deductible if you’re self-employed.

Re: Employer health plans are getting pricier and skimpier

#66

Post by mieseratte »

hfern wrote: post #46
taurath wrote: post #30

Earlier quoted context omitted.

Nobody does. The real translation is old people don’t want to change doctors.

It's worth pointing out that for the vast majority of people doctors != insurance. The payer is not the provider. The refrain of "people like their health insurance" deliberately conflates the two. People like their doctors, not their insurance. Doctors accept multiple insurance companies.

> Doctors accept multiple insurance companies.

Some do, but not all. One of my providers takes exactly one insurer, which I do not have, so pay out-of-pocket.

Luckily most insurance companies allow you to submit receipts to receive credit towards your deductible.

Re: Employer health plans are getting pricier and skimpier

#67

Post by war1025 »

KoftaBob wrote: post #12

This is why I feel the "most Americans like their health insurance" cliche is complete garbage.

I like my health insurance in the sense that I am fairly confident that I will like my current health insurance better than the insurance I will have in five years. The same way that I liked the insurance I had five years ago better than the insurance I have today.

Basically I think no one expects it to get better, so they are just all hoping it doesn't continue to get worse (while expecting that it will).

Re: Employer health plans are getting pricier and skimpier

#68

Post by mywittyname »

blahyawnblah wrote: post #16
vkou wrote: post #13

Of course they are, healthcare costs are growing in an unbounded manner, way ahead of inflation.

Why is this? Are there more sick people or just more people?

The healthcare system has become a symbiotic relationship where providers and insurance companies work together to funnel money from just about every business in the US into their pockets.

Hospitals increase staff to justify billing more, then insurance companies use increased costs to justify raising rates. Internally, hospitals and insurance companies are also in a tug of war over their slice of the pie. These conflicts introduce even more people-hours into the treatment of patients, in the form of revenue cycle managers, lawyers, medical coders, etc.

Each new layer added to the cost onion of healthcare results in the pie growing, since most insurance providers can only take in some percentage of what is spent. So they need to spend more to make more.

Re: Employer health plans are getting pricier and skimpier

#69

Post by lotsofpulp »

Ididntdothis wrote: post #27
throwawaysea wrote: post #19

The entire health insurance industry makes ~$25B in profits a year, correct? That doesn't seem overly large considering it is the entire insurance industry.

It’s not only profit. They also cause a lot of administrative overhead. For example if doctors had to deal only with one insurer or at least one coding system they wouldn’t need four billing assistants as I have seen. In essence insurance companies do a lot of unnecessary stuff. Their profit is only a small part of that cost.

Much of the administrative stuff insurers do to prevent healthcare providers from doing unnecessary stuff. In a taxpayer funded system, there would still have to be an entity to double check healthcare providers’ billing.
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