They really should offer the employee the option to take the benefit in cash instead of getting the health insurance then you could barter with the healthcare centers. The health insurance and healthcare centers(hospitals/clinics) are a cartel and the only way to bring down prices is through competition and that doesn't happen when you give an arbitrary amount of your paycheck to a clandestine insurance agency that has dubious relationships with the hospitals.
Employer health plans are getting pricier and skimpier
111–120 of 539 posts
Re: Employer health plans are getting pricier and skimpier
#112Earlier quoted context omitted.
> 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.
The US hasn't had compulsory private insurance up until about 10 years ago. Before that costs were going up even faster[1]. Even then if your employer is providing your health plan the amount of "shopping around" you can do is limited - most companies have 2 or 3 options (a PPO, an HMO and something with an HSA). This leaves only the uninsured (i.e. the poor) or previously uninsurable (pre-existing conditions) in the actual open private insurance marketplace. It's not surprising that premiums there will be crazy high and it's not really that close to being the Swiss model.
> our problem is something other than the payor model
I partially agree with that - the payer model is one facet among many. There are other problems with healthcare in the US. Hospitals can veto opening of competing hospitals in the area, complex billing, not enough residency spots leading to a shortage of doctors, whatever the F is happening with prescription drugs etc. GP was only asking for alternatives to employer healthcare though.
1. https://www.thebalance.com/causes-of-rising-healthcare-costs...
Re: Employer health plans are getting pricier and skimpier
#113The sooner we can completely divorce healthcare from employment, the better.
I hear this statement all the time...but what does it mean? If employers didn't provide health insurance to employees wouldn't we just wind up with 40% of the insured uninsured? Its not like Corporate America is going to make up the difference and start paying cash to compensate for the lost benefit, at least thats what happened as pensions got stripped away from the workplace. Even if the employer's did make up the…
There's two proven paths to do this on different ends of the spectrum.
The first is single payer which has proven implementation and is able to lower costs by directly controlling prices.
The second is what Switzerland does which is where much of the inspiration for the ACA came from, except every single person would be required to buy from the exchanges rather than using some employer program. The ACA failed to properly acknowledge the negotiation power of certain large employers who often have large numbers of healthy young employees and have a deep understanding of their own risk pool, leaving the ~3% of people who use the exchanges paying more simply because they are a higher health risk population. Additionally, the ban/tax on "cadillac" plans absolutely needs to go into effect as it's an important mechanism for controlling costs in a market health insurance solution, as in demand doctors could just require patients have said cadillac plans that pay out more.
There are handfuls of solutions in the middle of this, but they generally involve the government controlling prices to a certain degree, but only single payer would be effective at both bringing costs down and insuring more people, as you absolutely have to create short term shortages in order to solve both problems at once.
Re: Employer health plans are getting pricier and skimpier
#114Earlier quoted context omitted.
I hear this statement all the time...but what does it mean? If employers didn't provide health insurance to employees wouldn't we just wind up with 40% of the insured uninsured? Its not like Corporate America is going to make up the difference and start paying cash to compensate for the lost benefit, at least thats what happened as pensions got stripped away from the workplace. Even if the employer's did make up the…
Getting insurance as an individual is expensive because you’re not part of a group plan. With a group plan the insurance company has some reason to believe you’re not collectively a bunch of dying people committing moral hazard, you’re just one of a generally similar looking company workforce. If employers stopped providing it, I think it is presumed that the mentality towards individual plans would change
> Getting insurance as an individual is expensive because you’re not part of a group plan.
I see people say this constantly. Insurance by definition is literally always a "group plan"—everyone who buys insurance is in the same group. That's literally the point of insurance. It's why it exists. That's what it is. That is fundamentally how insurance works. All insurance, in every category, of every type. There are no exceptions.
Insurance always pools risk across all payers (everyone is in the "group"), and then you expect only a fraction (but we don't know which fraction, of course) to require a payout in any given payment period.
If you're selling something that doesn't work like that, then it's not insurance—by definition.
Re: Employer health plans are getting pricier and skimpier
#115Earlier quoted context omitted.
Its not exactly a chicken and egg problem then, and the solution doesn't start with divorcing insurance from employment. Put that "Medicare for All" into play first.
MFA is a single-payer option but there are plenty of multi-payer healthcare systems in the world which achieve universal coverage and contain costs. Germany would be the prime example, but see also Switzerland and France.
I like single payer, but I haven't had the luxury of living under either system of universal care.
I think in the US we have different issues than face Germany/Switzerland/France, and for the US to contain costs my opinion is we would have to rip private insurance out completely.
Our main Government provided system (Medicare for the elderly) is a combination of government and private, and to put that system in perspective, Germany spent 375B (not sure if $ or Euro) in healthcare total in 2017, and US Medicare spent $609B in 2017. Germany covered an entire country (82M people) Medicare covered 15% of the US (44M people).
Re: Employer health plans are getting pricier and skimpier
#116Earlier quoted context omitted.
The average health insurance monthly premium for individuals is a couple hundred dollars ($321 in 2017 per https://www.cnbc.com/2017/06/23/heres-how-much-the-average-a... ; it'll be higher now). $10 or $100/month both mean the employer is chipping in a bunch, they're subsidized via the exchange due to low income, or they've got absolutely garbage coverage that won't actually pay for anything significant. This is why…
My wife just took a job at a place that has a 'good' health insurance plan. If she opted into it, her contribution would be ~$300/month, her employer's contribution would be $900/month. If she wanted to cover me with it, her contribution would be $1,500/month, and her employer's would be $900/month. Unsurprisingly, we did not take advantage of this, and she remains on my insurance (Since my employer handles 90% of th…
Coinsurance is paid only until the out of pocket maximum is met, no?
I have a plan on the state exchange for around $300/month and an out of pocket max around $8k (I'm 34 years old).
I just budget $12k/year for healthcare and move on. This seems reasonable for people who can afford to take the risk of potentially having to pay anywhere from $4-12k/year.
Re: Employer health plans are getting pricier and skimpier
#117Earlier quoted context omitted.
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…
What you’ve described is the self-insurance model for large companies. That doesn’t conflict with any of my earlier comments. Companies can decide whether they want to administer it internally or use a consultant.
You seem to believe that just because a company uses a consultant that no one in HR or Finance or management would be privy to viewing your claims history via the consultant? Not sure what would lead you to believe that. Just because your company is outsourcing the task doesn’t mean it is shielded from the data.
Re: Employer health plans are getting pricier and skimpier
#118The sooner we can completely divorce healthcare from employment, the better.
Do you think that companies would give you a raise equivalent to what they were paying on your behalf for healthcare? I suspect not. I mean, it's one thing if we moved to a single payer system, which would be great, but just moving out of the employer's hands and into the general public seems like a disaster. (Also, I am not a fan of the employer healthcare model.)
That depends on the details. I'm sure to have missed a many important details below (I doubt anyone even knows them all).
For an instant raise to happen: companies must not only lose their tax deductions on what they contribute to insurance, they also need to count that contribution to employee's wages even if the employee doesn't take it. As soon as young childless employees realize that they are paying taxes on what amounts to the insurance payments to their co-worker who has a lot of kids they will demand they get the cash.
Re: Employer health plans are getting pricier and skimpier
#119Earlier quoted context omitted.
> 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.
The difference between Switzerland and the US is that in Switzerland pricing is regulated. The free market does not work when your life is at stake. You can shop around as much as you like for a butt enlargement and skip it if it's too expensive, but if you find a bat in the bedroom you need a physician straightaway, and then he will overcharge you.
Re: Employer health plans are getting pricier and skimpier
#120Even 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…
From my perspective, I am unlikely to hit the out of pocket maximum but quite likely to spend more than $1k/year. All the high deductible does is discourage you from seeking care for things before they become serious. Not sure how it worked from the employer’s end, but $5k/year will get taxed at roughly 50% before I see it so it’s not clear whether that will be greater than my out of pocket costs