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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

#301

Post by bobthepanda »

simonsarris wrote: post #295
romwell wrote: post #272

Earlier quoted context omitted.

Perhaps this is a good reason: >Literally, every Industrial Nation has addressed this problem for much lower costs with better out comes.

But why those nations have lower costs isn't so simple. If you remove all profit and admin overhead from the US system, its still something like $5000/person more expensive than other countries (I think that that was vs Canada). A large component of healthcare cost in the US is simply healthcare use. We are deeply, deeply unhealthy with 75% overweight rates and absurd levels of pre/diabetes, which are the largest com…

It's not just about cutting usage, it's about cutting the right kinds of usage as well.

Lots of Americans, anecdotally, skip out on regular checkups or checking on minor ailments because of anxiety about paying copays. And then eventually something that could've been easily treated when detected initially blows up into an expensive ER visit or requiring specialists.

A good chunk of this could be solved if we stopped using the ER as the catch-all emergency net for literally everything.

Re: Employer health plans are getting pricier and skimpier

#302

Post by war1025 »

lotsofpulp wrote: post #282
war1025 wrote: post #232

Earlier quoted context omitted.

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 c…

No, the bullet point right below the one you quoted states at least 7.5% of AGI spend is not deductible.

Hmm. Lame.

Re: Employer health plans are getting pricier and skimpier

#303

Post by philjohn »

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…

And what's more - look at the UK where we spend half as much per capita on healthcare and achieve broadly similar results. Yes, if you get a sporting injury you're going to be waiting 6-8 weeks for physio, but if you have a heart attack, cancer, are in a serious accident there is no wait.

Re: Employer health plans are getting pricier and skimpier

#304

Post by spaced-out »

GreenJelloShot wrote: post #286
romwell wrote: post #272

Earlier quoted context omitted.

Perhaps this is a good reason: >Literally, every Industrial Nation has addressed this problem for much lower costs with better out comes.

Really? So there are zero people from other industrial nations that come into the US for health care?

It's not a one way street, though. Americans go to other countries like Canada or Cuba for health care, including, famously, GOP Congressman Paul Ryan.

Re: Employer health plans are getting pricier and skimpier

#305

Post by throwaway66920 »

erichocean wrote: post #197
throwaway66920 wrote: post #130

Earlier quoted context omitted.

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)…

> There’s more retired old people. Medicare is mandatory in the US for retired old people. It's universal, it's mandatory, and it covers everything. They're literally not in the insurance pools, so I don't know what you're talking about. As for the "group plans", those "groups" are too small for insurance purposes—they do not spread risk effectively. The entire "group plan" thing is a scam, and it would be trivial fo…

> Medicare is mandatory in the US for retired old people. It's universal, it's mandatory, and it covers everything. They're literally not in the insurance pools, so I don't know what you're talking about

How about everyone who retired before 65?

As for your other points, I mean yeah, we shouldn’t have employers provide it. But they do, and you need to recognize it. There are definitely group plans large enough to spread risk.

Re: Employer health plans are getting pricier and skimpier

#306

Post by hristov »

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…

If you do not want to hear one thing about negotiating power then you are missing the main reason why medical costs are skyrocketing.

Medicare/medicaid does not negotiate drug costs down because it is prohibited by law from doing so. This is because of a law signed by the Bush administration (https://en.m.wikipedia.org/wiki/Medicare_Prescription_Drug,_...).

Re: Employer health plans are getting pricier and skimpier

#307

Post by adamredwoods »

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…

There is a WHY (or at least a general why): Obfuscation.

- lack of clarity on competitive pricing

- obfuscation by adding multiple layers in buying process (broker - insurance - claims adjuster - hospital)

- obfuscation through too-many-options syndrome (Obamacare versus Medicare versus state-driven healthcare versus emergency-only healthcare)

- lack of clarity when being billed (getting several bills from several different departments)

There's also the problem of insurance companies being a for-profit enterprise that answers more to stockholders than to patients.

This is the result of "free market" idealists at work. Health is something that everyone needs, so businesses want a piece of the big pie by trying to wedge themselves somewhere in there. Only massive government overhaul can fix this.

Re: Employer health plans are getting pricier and skimpier

#308

Post by js2 »

zaroth wrote: post #283
throwaway_law wrote: post #115

Earlier quoted context omitted.

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 perspe…

$375B for 82M people (~$4,500 per person) for Germany. Versus $609B for 44M people (~$13,800 per person) for Medicare. FYI, USA currently spends about $10,800 per person on healthcare, roughly $3.5 trillion. IMO, the discussion should revolve purely around pricing and efficiency. Negotiating power alone isn’t going to drive $1.5 trillion in costs out of the system. I would like to see basic pricing reforms demonstrat…

> Negotiating power alone isn’t going to drive $1.5 trillion in costs out of the system

Of course it could. It works in Germany! And France! And Switzerland! Why not here?

Look, I don't know how this can possibly work with our current system. It cannot be solved by the market alone. There's no transparency in the current system. Insurers can just keep passing price increases along. And many Americans want "the best" and "right now" and that ends up increasing costs for all of us.

People will argue that the American system is so expensive because: reasons. e.g. we subsidize the rest of the world. Or we are overweight. Or we don't get enough exercise. Or we want the best of everything. Or health insurance profits and CEO salaries. Or fraud.

We also keep saying: America is exceptional. None of what other countries do will work here.

So what do you propose? At the end of the day, doctors, hospitals, and the payer or payers need to negotiate reasonable pricing for decent care. And that cost needs to be spread equally across all Americans. I'd favor doing it with cost-sharing from paychecks like we do now for Medicare, with the government picking up the bill for the unemployed, and with tax credits to offset income differences. I like the system than France has, where you have a co-pay, but it gets reimbursed. This makes the consumer at least aware that there is cost to using the system. Then allow supplemental insurance for people who want better.

And Americans will somehow need to realize that not every medical problem has to be solved right away. And that you don't need the most expensive treatment option for every issue.

We cannot continue to ration health care by ability to pay. It's immoral.

Re: Employer health plans are getting pricier and skimpier

#309

Post by philjohn »

simonsarris wrote: post #295
romwell wrote: post #272

Earlier quoted context omitted.

Perhaps this is a good reason: >Literally, every Industrial Nation has addressed this problem for much lower costs with better out comes.

But why those nations have lower costs isn't so simple. If you remove all profit and admin overhead from the US system, its still something like $5000/person more expensive than other countries (I think that that was vs Canada). A large component of healthcare cost in the US is simply healthcare use. We are deeply, deeply unhealthy with 75% overweight rates and absurd levels of pre/diabetes, which are the largest com…

In the UK the NHS negotiates prices for drugs. NICE have to approve all drugs and if a drug is too expensive, the manufacturer either has to lower the price so that the benefit outweighs the cost, or they lose a large market.

This is why hand waving away "bargaining power" ignores one of the sources of high costs.

The other is that our doctors are mostly either employed by the NHS, or employed by a private provider who is paid by the NHS ... yes, there are doctors who do private only work, but they are fairly small in number.

Perhaps our student loans system also helps - fees are £9k a year, but you start paying them back at 9% of income over £25k ... so it's essentially a graduate tax and they are fully written off after a set number of years if you don't pay them off.

Re: Employer health plans are getting pricier and skimpier

#310

Post by claudeganon »

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.

It’s also an absolute moral disgrace that we’ve decide the profits of insurance industry and other for profit entities are more important than many people’s lives and the suffering of many others. Anyone who wants to argue in favor of the continued existence of this system should have all of this hung around their necks.
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