Employer health plans are getting pricier and skimpier • Hacker News Board

Re: Employer health plans are getting pricier and skimpier

#101

Post by throwaway_law » Wed, Sep 25, 2019, 7:50 PM UTC

triceratops wrote: post #91

throwaway_law wrote: post #43

Earlier quoted context omitted.

The articles is about employer health plans getting more expensive, the comment was about employer health plans getting more expensive...whats the alternative to an employer provided health plan? An individual private plan, I thought it seemed relevant those are increasing in cost too (at a much higher rate).

> whats the alternative to an employer provided health plan? There are a number of alternatives: 1. Government health plan at the state level (i.e. the Canada model) 2. Compulsory private insurance (i.e. the Switzerland model). But employers don't provide it and insurers have to insure everyone who pays. Single, larger, and more diverse risk pool instead of 3 separate pools - one with working age people and children,…

Yes, it would be great if US employees had those options, but they don't hence they aren't alternatives. The main alternative in the US to an employer based group insurance policy is an individual plan.

One day the US may catch up to the rest of the world, but unfortunately, the US seems content with millions of uninsured, healthcare related bankruptcies, and milking those who can afford coverage more every year in exchange for less.

Re: Employer health plans are getting pricier and skimpier

#102

Post by ihm » Wed, Sep 25, 2019, 7:50 PM UTC

KoftaBob wrote: post #12

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

It's not even a cliche -- it's a talking point from the insurance industry.

Re: Employer health plans are getting pricier and skimpier

#103

Post by makomk » Wed, Sep 25, 2019, 7:50 PM UTC

ceejayoz wrote: post #40

throwaway_law wrote: post #34

Earlier quoted context omitted.

Who is in charge of negotiating for this pool? Just as an example between 2017-2018 the average silver plan went up 32% and the average gold plan 20%, who the hell negotiated that? At least with the employer provided insurance the employer is negotiating, and you know who that is and you know they have a self-interest in keeping costs down.

Plans jumped in 2017-2018 because insurers had to factor in the possibility of Obamacare repeal. Last year saw a drop (down 1.5% in the 39 states using Healthcare.gov), and 2020 looks small thus far as well. https://www.politico.com/story/2019/06/03/obamacare-rate-hik... I, quite frankly, trust my state more than my employer in a fight against my insurer. I obtain coverage via the NY exchange.

The price of insurance jumped massively every year from the start of Obamacare to 2018. The fact that this has apparently mostly stopped now is the unusual thing; 2017-18 was a pretty typical year despite Trump's meddling. The article you linked suggests that this is because insurers have finally increases the cost of insurance to be in line with how much it actually costs them.

Re: Employer health plans are getting pricier and skimpier

#104

Post by mieseratte » Wed, Sep 25, 2019, 7:51 PM UTC

tempsy wrote: post #89

mieseratte wrote: post #76

Earlier quoted context omitted.

> 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. Because they partner with a larger provider for the doctor / hospital / pharmacy networks and specialist support. This is a very common pattern insofar as I'm aware. Has your experience differed?

The network of providers available to you is a separate issue from whether your company manages the risk or an insurance company does. Didn’t mention anything about provider networks.

> The network of providers available to you is a separate issue from whether your company manages the risk or an insurance company does

What I'm saying is, my company manages the risk. We partner with a larger insurer company that provides A) network B) specialists for the roles you've claimed a company would normally hire. Because of this we don't have inside actuaries and specialists and such. As a result, there is no inside man looking at my claims.

I will ask for for a third time, have you experience that differs here?

Re: Employer health plans are getting pricier and skimpier

#105

Post by criddell » Wed, Sep 25, 2019, 7:51 PM UTC

vkou wrote: post #13

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

Wouldn't you expect that with an aging population?

Re: Employer health plans are getting pricier and skimpier

#106

Post by rayiner » Wed, Sep 25, 2019, 7:52 PM UTC

triceratops wrote: post #91

throwaway_law wrote: post #43

Earlier quoted context omitted.

The articles is about employer health plans getting more expensive, the comment was about employer health plans getting more expensive...whats the alternative to an employer provided health plan? An individual private plan, I thought it seemed relevant those are increasing in cost too (at a much higher rate).

> whats the alternative to an employer provided health plan? There are a number of alternatives: 1. Government health plan at the state level (i.e. the Canada model) 2. Compulsory private insurance (i.e. the Switzerland model). But employers don't provide it and insurers have to insure everyone who pays. Single, larger, and more diverse risk pool instead of 3 separate pools - one with working age people and children,…

Doesn’t the fact that vastly different systems perform better than the US possibly suggest that our problem is something other than the payor model? What is the theoretical reason why US costs would be higher than Switzerland? Premiums for private insurance should be much lower in the US, given that Medicare takes high cost people out of the private pool.

Re: Employer health plans are getting pricier and skimpier

#107

Post by throwaway_law » Wed, Sep 25, 2019, 7:56 PM UTC

throwaway66920 wrote: post #94

2sk21 wrote: post #83

Earlier quoted context omitted.

Well, one way of looking at it is that the general population is the biggest group possible :-)

Sort of. This is true if everyone is required to participate in the system. And there’s only one provider. If you imagine there being a cheap plan and an expensive plan, you would probably expect that the expensive plan is a way better return on the dollar because there are fewer poor people on it weighing it down (because poor people are likely to have more health issues). True meaning it averages out to a reasonabl…

>you would probably expect that the expensive plan is a way better return on the dollar because there are fewer poor people on it weighing it down

It is unfortunately true in the US (probably everywhere) there is worse health/higher incidences of chronic conditions in the poor (mostly because all chronic conditions are diet related). However, in the US the biggest weight would be the elderly who have chronic conditions at a higher rate than any other demographic (generally due to a lifetime of poor diet combined with irregular care over their life to treat the conditions until they are Medicare), but thats the irony these are the people already covered by Government healthcare (and they seem fairly happy with it. Its time to extend it to everyone.

Re: Employer health plans are getting pricier and skimpier

#108

Post by tvanantwerp » Wed, Sep 25, 2019, 7:57 PM UTC

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…

Wow. I work in a 30-40 person office. My plan, which is the nicest available to us, is ~$300/month. Deductible is $1.5k single and $3k family, and I don't have any nice wellness perks like you described. Overall, I hate this plan. It will be handy if I ever get hit by a car and need lots of pricey surgery, but otherwise not so much. The price will be going up about 15% next year.

Re: Employer health plans are getting pricier and skimpier

#109

Post by cullenking » Wed, Sep 25, 2019, 7:57 PM UTC

opportune wrote: post #84

Even at famously generous employers they will try very hard to push you towards high deductible plans by giving you 1-2 thousand extra dollars per year in your HSA. Of course the high deductible plans discourage you from seeking care so it saves your employer peanuts it can add to its war chest in Ireland Some of this probably has its roots in the ACA adding extra taxes onto “Cadillac insurance plans” though which I…

I manage a health plan for our smallish business of 19 employees. We offer "pretty good" health insurance, meaning, we pay around $600 per employee per month for health and dental. It gets worse every year. I am considering moving toward a HSA based plan, because upon analysis, it's actually probably better for everyone involved. The max out of pocket per year is the same, but instead of a $1000 deductible you have a $5k deductible. This works for our business (and I am assuming a bunch of other tech businesses) because our employees are generally young and in good health. It's a cheaper plan, the worst case scenario for an employee is the same, and I can give raises for the difference in price, and once every few years someone will need more than a $1k deductible, but the raise from the last couple years greatly exceeds the one time cost.

Anyway, just trying to frame my logic here, because I don't consider myself an evil employer trying to skimp on health insurance for my employees (which many I consider friends), but an employer that has to approve health plan changes annually which each increase cost by a considerable amount. If this trend continues, each employee will cost $900 a month within 5 years, and the coverage will be half as good. That's $5k a year per employee that I could put into their salaries, while not screwing anyone over on the worst case scenario.

Re: Employer health plans are getting pricier and skimpier

#110

Post by nickgrosvenor » Wed, Sep 25, 2019, 7:57 PM UTC

This is absolutely the biggest story in America, and most people aren't talking about it.

An entire generation is draining their savings to keep up with premium costs.

Not to mention the millions of people locked into careers they would otherwise get out of, if not for the health coverage.

This situation is probably going to lead to unbelievable outcomes.