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

Re: Employer health plans are getting pricier and skimpier

#391

Post by pravda » Thu, Sep 26, 2019, 1:16 AM UTC

flukus wrote: post #374

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. This is what happens with corporate healthcare plans already, those costs get past onto the consumer (middle to upper middle class) and they pay a hidden healthcare tax on every purchase.

Heathcare costs are part of employee compensation. The tax is on employees.

Re: Employer health plans are getting pricier and skimpier

#392

Post by souprock » Thu, Sep 26, 2019, 1:18 AM UTC

Apes wrote: post #385

comnetxr wrote: post #360

Imagine if grocery stores forced us to choose one of a few dozen grocery "insurance" memberships to buy groceries, and negotiated directly with the insurers. No prices are labeled in store, they just detect whatever you take and send you a bill at the end of the month. (Differing brands of the same food product are not available in store of course.) Individuals are charged 3-100x more per product than negotiated rate…

Consumers using grocery insurance would have no real say or insensitive in what groceries they get - it doesn't matter if all they need is some chicken and a cheap wine. All the grocery store sells are filet mignon and Dom Perignon, and that's what everyone gets.

With healthcare, it goes the other way too.

When my kid gets a deep gash, disfiguring an eyebrow or messing with an important finger, I'd be willing to pay extra for a surgeon to sit there with a microscope putting all the little capillaries and nerves back together. I'm offered a staple, or some glue, or maybe a couple stitches. No, I really don't like zig-zag eyebrows and stiff numb fingers.

Anybody know how to get the good treatment?

Re: Employer health plans are getting pricier and skimpier

#393

Post by Spivak » Thu, Sep 26, 2019, 1:19 AM UTC

plughs wrote: post #383

comnetxr wrote: post #360

Imagine if grocery stores forced us to choose one of a few dozen grocery "insurance" memberships to buy groceries, and negotiated directly with the insurers. No prices are labeled in store, they just detect whatever you take and send you a bill at the end of the month. (Differing brands of the same food product are not available in store of course.) Individuals are charged 3-100x more per product than negotiated rate…

Then imagine that there are some people who can't afford the food they need in the grocery store and are going to die. Alternatives and transparent pricing isn't going to make brain surgery affordable to the average consumer.

Solving the problem of care that a person can’t afford is a completely different issue than fixing the problem of routine affordable care being exorbitantly expensive.

Re: Employer health plans are getting pricier and skimpier

#394

Post by flukus » Thu, Sep 26, 2019, 1:21 AM UTC

pravda wrote: post #391

flukus wrote: post #374

Earlier quoted context omitted.

> One thing that will not make healthcare less expensive is "Medicare For All". It will just shift the bill to different people. This is what happens with corporate healthcare plans already, those costs get past onto the consumer (middle to upper middle class) and they pay a hidden healthcare tax on every purchase.

Heathcare costs are part of employee compensation. The tax is on employees.

Any evidence of this? Some quick googling and I couldn't find anything about about employees with healthcare plans being paid less than employees without them.

If I understand the history of it properly, healthcare was always meant to be an extra incentive from a period where they weren't allowed to pay more. It's never been a tax on employees.

Re: Employer health plans are getting pricier and skimpier

#395

Post by journalctl » Thu, Sep 26, 2019, 1:24 AM UTC

ergothus wrote: post #181

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 m…

Healthcare is driven by profits in the US and in the absence of any safeguards companies will charge as much as they can get away with.

Re: Employer health plans are getting pricier and skimpier

#396

Post by pravda » Thu, Sep 26, 2019, 1:25 AM UTC

madengr wrote: post #296

Turing_Machine wrote: post #219

Earlier quoted context omitted.

> Knock on wood but, myself and pretty much everybody I know has insurance covered ~75% through our full time employers. That is money that would otherwise be given to you in the form of salary, so, yeah, you're paying for it even if it doesn't seem like it. Historically, the main reason for employer-provided health insurance in the U.S. is that it provided a loophole to increase effective employee compensation in a…

My employer dropped dental insurance a few years ago. They never gave me a pay bump to compensate. Now I spend $1,600/year on cleanings for a family of 4. At least it is out of my HSA, so pre-tax.

$400 for a cleaning?! You gotta negotiate better!

That is an outrageous price!

Re: Employer health plans are getting pricier and skimpier

#397

Post by CyanLite2 » Thu, Sep 26, 2019, 1:34 AM UTC

It's the supply, stupid.

Congress limits the number of medical school students, thus limiting the supply of doctors.

You see all kinds of programs to introduce more STEM or coding camps into public schools. But you won't see schools encourage more doctors. Why? Because of special interest groups.

Re: Employer health plans are getting pricier and skimpier

#398

Post by kevindong » Thu, Sep 26, 2019, 1:34 AM UTC

basseq wrote: post #129

tempsy wrote: post #10

Yep, and what people don't always realize is that because employer health plans get more expensive every year for employers, it negatively impacts wage growth. You are paying for it even if you don't necessarily feel it.

This is really important. Pulled from the underlying study[1], employers cover 82%/70% (individual/family) of the cost of healthcare. Those numbers are down just slightly from 86%/73% in 2019. Or, put another way, employers have borne 69%/80% of the cost of healthcare increases. You complain because your individual plan has gone up by $986 in 20 years? Your employer's cost has gone up $4,005 . Oh, and that's with cut…

> Finally, note the disparity between individual and family plans. Employers are offering 2.5x more benefit—nearly $9,000 more—to workers with families.

Interestingly, my employer discloses the full premium that they pay to the health insurer every year. As an employee without a partner/dependents (I just graduated college/started my career), my employer spends ~$17k/year less on my health/dental/vision benefits than employees with a partner/dependents.

That effective pay difference makes me mildly salty.

Re: Employer health plans are getting pricier and skimpier

#399

Post by kuzimoto » Thu, Sep 26, 2019, 1:40 AM UTC

plughs wrote: post #383

comnetxr wrote: post #360

Imagine if grocery stores forced us to choose one of a few dozen grocery "insurance" memberships to buy groceries, and negotiated directly with the insurers. No prices are labeled in store, they just detect whatever you take and send you a bill at the end of the month. (Differing brands of the same food product are not available in store of course.) Individuals are charged 3-100x more per product than negotiated rate…

Then imagine that there are some people who can't afford the food they need in the grocery store and are going to die. Alternatives and transparent pricing isn't going to make brain surgery affordable to the average consumer.

According to Wikipedia, there are only .5% of all physicians in the US who can perform neurosurgery. So it's probably safe to say the demand for brain surgery is much higher than the supply.

This incentivises people to become doctors that perform such complecated procedures as it takes a lot of time and a lot of money to be able to do those things.

If you were to force doctors to perform work on people that can't afford it, then presumably they will earn less money. If they earn less money, there is less incentive to do that kind of work as they will pick something easier and more profitable.

You will end up with fewer people to do brain surgery.

Re: Employer health plans are getting pricier and skimpier

#400

Post by pravda » Thu, Sep 26, 2019, 1:44 AM UTC

flukus wrote: post #394

pravda wrote: post #391

Earlier quoted context omitted.

Heathcare costs are part of employee compensation. The tax is on employees.

Any evidence of this? Some quick googling and I couldn't find anything about about employees with healthcare plans being paid less than employees without them. If I understand the history of it properly, healthcare was always meant to be an extra incentive from a period where they weren't allowed to pay more. It's never been a tax on employees.

Ask yourself this question: why does anyone get paid more then minimum wage?