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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

#251

Is there even a single non-political way that plan buyers can, even in aggregate, do something about this?

Stop getting sick and having to use the healthcare system. So no, not really, unless we change our living habits as a civilization, but then we get old anyway.

Well, I think there's some literal truth to that.

Even though I seem weirdly unable to get sick, and I've been to a doctor once in 15 years (just to get a note! required by other insurance), I still have to pay unfunny premiums. So being super healthy still doesn't help.

AND YET if everyone in aggregate used less healthcare, I bet it would do more to move the needle than anything a politican plans. Americans are deeply, deeply unhealthy and I wish I could convince them all to eat better. To me it is just wild that so many people complain about non-insurance healthcare costs but do not want to invest in better food/behaviors for themselves.

Re: Employer health plans are getting pricier and skimpier

#252

Earlier quoted context omitted.

We’re just gonna pretend Europe, Australia, Japan, Canada etc. don’t exist?

Those countries are smaller and most likely have more functional governments than the United States. Having a dysfunctional government is a feature, not a bug, but it does mean that the national government would do a bad job running the health care system.

Germany's nearly 90 million people. What about a 90 million person health system can't be done with 300 million? At what point does this magical impossibility kick in?

Re: Employer health plans are getting pricier and skimpier

#253
post #20

Earlier 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…

We would do what every other country does and offer healthcare as a basic right? The whole point of "Medicare for All" is to divorce employers from their employee's healthcare. The gov't negotiates on behalf of everyone.

The government negotiating rates on behalf of all citizens is not the same as the government paying 100% of all citizens' costs. "Medicare for All" is the latter; but all we really need is the former. Basically the government could do on behalf of all citizens what it already does on behalf of government employees and elected officials: negotiate with providers to come up with a menu of plans, and then let each person/family select the plan from the menu that works best for them. Who pays what part of the premiums and costs is a separate question.

Re: Employer health plans are getting pricier and skimpier

#254

Does anyone know the extent to which this is happening faster or slower than the background increase of medical care costs? I know that historically medical care costs have been outpacing inflation. So it's not altogether surprising that, in an unsubsidized environment, the costs to the end-user of that care would also increase, by roughly the same amount.

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Re: Employer health plans are getting pricier and skimpier

#255

Earlier quoted context omitted.

> 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…

You see it constantly because it is true. A group plan is a thing. Yes you’re still in a “group” when you register as an individual, but it is an “individual plan” and semantics doesn’t really help you out. The difference is that if I know the mean and variance of expected health costs for the group, I can offer a lower premium to every individual member because the variance of total actual cost goes down by n^(-1/2)…

That's all fine in theory, but do some shopping-around and you'll see it's simply untrue.

Personal anecdata:

2018, my employer didn't offer insurance. I signed up for a "silver" tier individual plan ($1250 deductible, good coverage) on the ACA marketplace and paid $170-something/mo. (after receiving ~$250/mo. in tax credit).

2019, my employer starts offering insurance, so I'm no longer eligible for the ACA tax credit. The only plan they offer costs me $125/mo., has a $4500 deductible, and extremely skimpy coverage. According to the literature they gave us, my employer's pitching-in another $400-something/mo.

So this group plan costs significantly more, has a much higher deductible, and covers significantly less (in my case, it's the difference between medication being covered and not).

Re: Employer health plans are getting pricier and skimpier

#256
There aren't many industries where price shopping is as hard as healthcare. When you remove the cost of a good so far from the actual beneficiary costs become incredibly hard to control.

Not many here will remember when the insurance markets started in the US, but the original deal was that people pool their resources and get a discount vs street rates. However now that everyone is pooled, what possible metric can you use to determine if you are actually getting a good deal?

Sure, we hear stories of outrageous bills that are sent to patients that their health insurance "covers". However, the reality is the insurance company expects a discount which has caused an opposite effect to uninsured patients. Costs go up so that the "deal" the insurance company gets looks good. All the stories about $20 pill of Advil, is all pointing to the leverage hospitals and doctors used to fight cost cutting at insurance providers.

I think there are only two ways to resolve this at this point. Build a free market solution where price transparency is required and make it easier to shop for non-emergency care, while the government continues to cover emergency visits or full single payer healthcare with the government footing the bill.

Based on the moral logic that many U.S. citizens see healthcare and life savings services as fundamental right, I think we inevitably will need a single payer system in the US. I know the desire is to see something federally mandated but I am quite surprised that not one state has taken up the idea of single payer and made it a system available to all residence who prove they have resided in their state at least X days. I'd like to see the different solutions presented in each state and let the state with the best healthcare solution win and eventually become federal.

Re: Employer health plans are getting pricier and skimpier

#257

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…

You should have both public and private options at the same time. In Spain you have a good public system but you also have a parallel private system. It keeps a check on the price rise of private insurance as people have the option. For a family of four I pay 300 EUR a month for the best plan. Most people pay about 180 EUR for four people.

Re: Employer health plans are getting pricier and skimpier

#258
post #160

Earlier quoted context omitted.

I loved my health insurance before Obamacare. I had a nice catastrophic coverage plan that was perfect for me. Now those are illegal.

Same here. Obamacare made my insurance SO much worse, and so much more expensive.

I think most people doubt the cost increases, but personally I pay about 10x what I used to pay for worse coverage. My deductible and out of pocket max is higher now too.

Re: Employer health plans are getting pricier and skimpier

#260
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…

You're forgetting that medicare for all also comes with a lot of promises about free education. The artificial barriers for education will be slowly removed and the supply will quickly match up the demand.

The solution isn't going to fix everything immediately, but it IS required for a full solution.

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