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

Re: Employer health plans are getting pricier and skimpier

#231

Post by geggam » Wed, Sep 25, 2019, 8:54 PM UTC

TheOtherHobbes wrote: post #210

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

The medical insurance industry is a free market. That's why it's such a disaster. "Free markets" are certainly not free in any meaningful sense of the word. In practice they make no distinction between activities that provide customer value for a competitive price, and activities that are institutionalised economic extortion maintained by political lobbying and regulatory capture leveraged by plentiful access to capi…

Eliminate all insurance. It's an algorithm to take profit from shared costs based on fear

Re: Employer health plans are getting pricier and skimpier

#232

Post by war1025 » Wed, Sep 25, 2019, 8:54 PM UTC

lotsofpulp wrote: post #62

war1025 wrote: post #57

Earlier quoted context omitted.

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.

My reading of this [1] seems to match up with what I said:

"""

- If you buy health insurance through the state- or federally run health insurance marketplaces, you can deduct only the portion of the premium you pay out of your own pocket. You cannot deduct the amount of any subsidy.

- If you buy an individual or family health insurance plan, either on the open market or through a marketplace, and you pay all of the cost out of pocket, then the whole amount is deductible.

"""

[1] https://www.insurance.com/health-insurance/health-insurance-...

Re: Employer health plans are getting pricier and skimpier

#233

Post by refurb » Wed, Sep 25, 2019, 8:55 PM UTC

jbeckham wrote: post #17

vkou wrote: post #13

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

And the largest portion of that is due to specialty drugs.

Total pharmaceutical spending is about 10% of all medical costs. Specialty drug is probably less than half.

Re: Employer health plans are getting pricier and skimpier

#234

Post by bdcravens » Wed, Sep 25, 2019, 8:55 PM UTC

arcticbull wrote: post #211

bdcravens wrote: post #153

Because medicine isn't paid for as a government-provided service. Insurance companies exist to profit - they defer risk. It is not a public service. I have a pre-existing condition, and I have a very mild case of Cystic Fibrosis: my healthcare at market costs about $500k a year. There's a lot of nuance to how much insurance companies actually pay out, etc, but looking at it in a simplified manner, it takes 25 familie…

Time to change that! :)

No doubt. The tough questions are around where will the sacrifices be made?

Re: Employer health plans are getting pricier and skimpier

#235

Post by lrem » Wed, Sep 25, 2019, 8:57 PM UTC

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.

On the other hand: since automation is eating the useful jobs and we're not getting UBI any time soon, maybe that's for the better?

Re: Employer health plans are getting pricier and skimpier

#236

Post by [deleted] » Wed, Sep 25, 2019, 8:58 PM UTC

[deleted]

Re: Employer health plans are getting pricier and skimpier

#237

Post by adolph » Wed, Sep 25, 2019, 9:00 PM UTC

throwaway_law wrote: post #14

badrequest wrote: post #5

The 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…

I think the concept of separating healthcare coverage from employment is an important first baby step to bringing costs down in that it makes healthcare consumers more aware of how much they are spending instead of hiding it as off-paycheck compensation.

This awareness can be raised in other ways. For example, some employers have added a chart in HR websites that outline how much is spent on each employee (it is personalized for each employee) in categories of wages, taxes, retirement, healthcare and the like. It is a way of communicating how much money is expended on an employee.

If one were to know how much was spent on one's healthcare coverage, would the average person think "ok, need to be efficient to get that number down" or "gosh, I better get what I'm paying for?" In the sense that healthcare plans are transfers from the healthier to the sicker, one would hope the former. In the sense that healthcare plans are almost-all-you-can-eat buffets of medicine, I think the latter is more likely.

Re: Employer health plans are getting pricier and skimpier

#238

Post by payne92 » Wed, Sep 25, 2019, 9:00 PM UTC

I just got my renewal quote: $2,372/month for a family of 4 is going to $2,883/month. That's a ~20% increase, to $34,595 PER YEAR.

(And this is while benefits continue to be cut back: $150/month for many prescriptions, etc.)

As others have written, there's no single reason. But, I think there's a major unintended structural problem: under US law, insurance companies are required to pay a high percentage (like ~90%) of their premiums out to service providers. The intent is to cut administrative overhead.

The effect: it's very hard for an insurance company to invest in technology or administrative improvements. So, the status quo persists.

WORSE, the admin overhead is pushed onto the providers, so the overhead cost gets hidden. It's not uncommon for a family medicine general practitioner to have a back office of 3-5 people dealing with billing and insurance paperwork.

Re: Employer health plans are getting pricier and skimpier

#239

Post by simonsarris » Wed, Sep 25, 2019, 9:00 PM UTC

mullen wrote: post #218

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…

> One thing that will not make healthcare less expensive is "Medicare For All". It will just shift the bill to different people. Now, you can argue it's the morally correct course of action, or those people who will be forced to foot the bill (upper middle class taxpayers) are more capable of doing so, but you cannot credibly claim with a straight face that it will make anything cheaper. In fact, the opposite will oc…

> Having every person under the same plan that has the negotiating power of 327.2 million people will definitely drive costs down.

Why do you think this would be true? Why do you think the bargaining power would work the way you think it would?

If you were correct, then cop cars must be fairly cheap compared to normal cars. Is this the case?

What about other goods? Laptops? Cruise missiles? etc.

Actually is it true for any good which the US Gov is the sole buyer? Can you think of even a single good where your supposition is true?

Re: Employer health plans are getting pricier and skimpier

#240

Post by notadoc » Wed, Sep 25, 2019, 9:06 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…

> Medical schools/the AMA are artificially limiting the number of students and residents for their own ends (keeping wages and scarcity high) so they need to charge a lot...

That sounds like a strange conspiracy, do you have evidence to support that?

Keep in mind 20+ years ago that insurance was much cheaper, deductibles were almost nonexistent, and care networks were giant. Talk to your US parents or grandparents about their costs of health care, you'll still be stunned at how much cheaper it was. Medical schools and the AMA still existed then too BTW.