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

Re: Employer health plans are getting pricier and skimpier

#181

Post by ergothus » Wed, Sep 25, 2019, 8:34 PM UTC

eric_b wrote: post #148

The problem is that there is not a single reason that healthcare is so expensive. Even if you list the top 15 reasons, you still have to apply the "5 whys" to each of them to find root causes and possible solutions. - Doctor's are paid too much... why? - Well they need to be paid a lot because medical school debt is 250k or more... why? - Medical schools/the AMA are artificially limiting the number of students and re…

> Medicare/Medicaid cover more people than many single payer systems in other countries, and their costs are still outrageous

I appreciate your reasonable breakdown, but I don't understand this one. I've seen many reports talking about how the costs of basic supplies and procedures are dramatically higher in the US (and vary wildly within the US). Things like X-Rays, MRIs, etc, being off by an order of magnitude or more (though I'm sure if the median price differences are less dramatic than the extreme examples, the results I vaguely recall said there was still a noteworthy difference)

How does this not indicate some fundamental difference between the US and other "developed" nations outside of the factors you list above? (Honest question)

Re: Employer health plans are getting pricier and skimpier

#182

Post by geggam » Wed, Sep 25, 2019, 8:34 PM UTC

baq wrote: post #155

kemiller2002 wrote: post #133

Earlier quoted context omitted.

Oh I'm sure the military doesn't pay that much. They get to leverage staff doctors, and negotiated rates. You know like other countries with single payer systems, etc. get. People in the U.S. get screwed, because hospitals are businesses, and they know how much they can charge to make a profit. When a hospital has an entire legal arm just for suing people in court, because they aren't making their payments, you know…

isn't the problem actually that there is no limit on what they can charge? if i have an accident they won't ask me if i agree on the price, they just charge me while i'm unconscious. i don't get to negotiate prices and the ambulance will take me to the closest hospital, not the cheapest for me.

not only that... your healthcare provider has contracts with the insurance company and the insurance company can actually block you from simply paying cash for services.

Let that sink in a bit

Re: Employer health plans are getting pricier and skimpier

#183

Post by tempguy9999 » Wed, Sep 25, 2019, 8:34 PM UTC

solarwind wrote: post #161

baggy_trough wrote: post #137

If you think health care is expensive now, wait until it's free.

This. Spreading the cost of something that's getting increasingly more expensive across the populace doesn't solve the fundamental factors that are causing that thing to become more expensive in the first place. It also removes the incentives to fix the underlying issues.

Sympathy and support for the organisationis bleeding your bank account dry. Carry on, mate.

Re: Employer health plans are getting pricier and skimpier

#184

Post by zeppelin101 » Wed, Sep 25, 2019, 8:35 PM UTC

If this is the price of living in the land of the free (and the home of the brave), then count me in. Freedom isn't free, folks! /s

Re: Employer health plans are getting pricier and skimpier

#185

Post by chooseaname » Wed, Sep 25, 2019, 8:36 PM UTC

notTyler wrote: post #132

knob wrote: post #125

Sharing this idea in order to gather critique. The cost of healthcare in the USA is insane. Could we look for insight into the US Military? Example: This morning, a coworker told me she's going to have an operation on her back. The "cost of the tray" (I have no idea what this is) is $14,000. She has to pay $8,000 up-front two days before the operation, and the remainder will be financed over two years. To me, it's in…

The insurance companies are for profit corporations who pay politicians so they can keep taking your money when you're healthy and cutting you when you're not. The army is not, as far as I know, a for profit enterprise.

This is the one and true answer with regards to insurance companies.

Re: Employer health plans are getting pricier and skimpier

#186

Post by throwaway22424 » Wed, Sep 25, 2019, 8:36 PM UTC

nickgrosvenor wrote: post #110

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.

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

Replying with a throwaway for obvious reasons. I work at one of the big tech companies -- I'm paid well, but the benefits are very good. I just got an offer from a startup that I really like. It's a job I would like to take.

I'm going to have to turn down the offer. Part of the reason I'm going to have to turn it down is that even though it offers insurance, its coverage isn't as good as what I have and the subsidy offered will add $15k a year minimum to my health care expenses. My partner needs surgery (an expensive surgery), and I'm the primary bread-winner (for now) -- I have to make pragmatic decisions because of stuff like healthcare, even at the expense of my own aspirations.

And to be clear, my scenario is significantly better than so many others who are stuck in truly terrible places (where I work is not terrible by a longshot) or in careers they would like to change, because the truth is, health care in the US is a joke.

Re: Employer health plans are getting pricier and skimpier

#187

Post by geggam » Wed, Sep 25, 2019, 8:36 PM UTC

dnadler wrote: post #175

geggam wrote: post #152

Earlier quoted context omitted.

Simply removing insurance and letting the free market adjust would fix the issue. When I was a kid no one worried about hospital bankrupting the family. Now anything larger than a paper cut has the chance to bankrupt most families. Combine that with the accident rate in cars you have an almost certain chance for a large percentage of the US to be bankrupt

That would kill a lot of people as the market adjusts...

Yep, solve global warming crisis, food crisis, insurance crisis

Life is harsh and the system we have setup will require this or war to change.

You pick how the death happens. The fact death has to happen for change is inevitable ( channeling thanos here )

Re: Employer health plans are getting pricier and skimpier

#188

Post by baq » Wed, Sep 25, 2019, 8:36 PM UTC

geddy wrote: post #180

eric_b wrote: post #148

The problem is that there is not a single reason that healthcare is so expensive. Even if you list the top 15 reasons, you still have to apply the "5 whys" to each of them to find root causes and possible solutions. - Doctor's are paid too much... why? - Well they need to be paid a lot because medical school debt is 250k or more... why? - Medical schools/the AMA are artificially limiting the number of students and re…

> Doctor's are paid too much... why? You can also branch off here: because malpractice insurance is insanely expensive. Why? Because people sue over absolutely everything. Why? Because lawyers in this country are vultures. If anything is overly expensive, you can usually track it back to insurance costs somewhere, which can typically be tracked back to the fact that we live in a litigious society.

they sue and get awarded insane damages, which is probably something that could be regulated more strictly, but then what do i know.

Re: Employer health plans are getting pricier and skimpier

#189

Post by nemothekid » Wed, Sep 25, 2019, 8:37 PM UTC

eric_b wrote: post #148

The problem is that there is not a single reason that healthcare is so expensive. Even if you list the top 15 reasons, you still have to apply the "5 whys" to each of them to find root causes and possible solutions. - Doctor's are paid too much... why? - Well they need to be paid a lot because medical school debt is 250k or more... why? - Medical schools/the AMA are artificially limiting the number of students and re…

>- Doctor's are paid too much... why?

Haven't doctor's historically had high salaries? Becoming a doctor requires years of training which leads to a low supply of doctors for a field that has always had high demand. Likewise, Doctors seem to be overworked so I'm not sure I can say they are being overpaid.

I don't think all the money that is being spent on healthcare is actually being funneled into doctors pockets.

You did say there are a top 15 reasons, but I think doctor salaries are a bad example.

Re: Employer health plans are getting pricier and skimpier

#190

Post by arcticbull » Wed, Sep 25, 2019, 8:37 PM UTC

greenonions wrote: post #138

What makes health insurance cheaper is a larger pool of people. There is no other mechanism by which costs can be reduced. This is why a single payer system is dramatically cheaper. It ensures complete coverage, reducing the cost of insurance to it's minimum. Furthermore, it leverages the collective bargaining power of all subscribers. There is no substitute for a national health insurance, and the United States slow…

Yep, it certainly does. Single-payer and socialized systems are cheaper for a lot of reasons:

(1) Purchasing power of a large, single negotiating entity to reduce the cost of drugs (that's how Canada does it, and the US' solution was to allow importation of Canadian drugs, which, uh, seems circuitous).

(2) No marketing expenses, no executive compensation, no claims denials, no billing, etc. This amounts to 15-20% of all healthcare spending in the US [1] -- so an instant 20% reduction right there.

(3) National ability to set compensation, so you can reduce the cost of physician services too, as they're now public servants. Canadian doctors still make mid-6-figure salaries, and frankly, I'm okay with that.

(4) Complete pricing transparency. Wanna know how much medical care costs in Ontario? It's all right here in one big PDF [2]. PET scan for Thyroid cancer? J702. $237.50 CAD.

(5) Improved balance sheets and lower operating costs for corporations who now no longer have to deal with the medical care of their employees for no rational reason. Improved competitiveness of small businesses vs larger ones where small businesses need to offer medical care for competitive reasons and it represents a disproportionate burden.

(6) People can take the risk of starting businesses without fear of death due to lack of medical care.

The list of benefits goes on and on. It's time to take action.

[1] https://naic-cms.org/cipr_topics/topic_medical_loss_ratio.ht...

[2] http://www.health.gov.on.ca/en/pro/programs/ohip/sob/physser...