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

Re: Employer health plans are getting pricier and skimpier

#441

Post by nixgeek » Thu, Sep 26, 2019, 4:57 AM UTC

onion2k wrote: post #439

nine_k wrote: post #417

Earlier quoted context omitted.

Regarding Europe, which I happen to have friends all over: it's not exactly as rosy. European countries do have more doctors per capita, which is good. They don't have nearly as much resources in the system, though. Come to a doctor with a bad cough, get a prescription for Paracetamol. You got to have a pretty bad infection to get a prescription for an antibiotic. Endure a long discussion with a doctor to renew an an…

Wait for two weeks to get an appointment about your coughing and sneezing. Here in the UK you can get an appointment to see your GP the following day most of the time, and we have walk-in clinics for same day check ups if you don't care which doctor you see. Availability varies a lot around the country but its mostly good.

This was not the case in Bristol when my GP took 2+ weeks to see me for the first time, then upon arrival, pawned me off on a nursing assistant rather than a doctor, then happily prescribed antibiotics for an “STI”, and then ignored my asks for a follow-up appointment for 2+ more weeks.

It turned out to be cancer. Original complaint stated when trying to book the appointment was “I have a testicle the size and hardness of a golf ball”.

Through that now, but the NHS is dysfunctional compared with U.S. healthcare. I have several relatives with bad hips or knees in U.K. who got prescribed stronger and stronger painkillers for >6 months because the waiting list for surgical intervention in their cases was so long.

Re: Employer health plans are getting pricier and skimpier

#442

Post by Ididntdothis » Thu, Sep 26, 2019, 5:03 AM UTC

analog31 wrote: post #402

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…

What I've noticed is that everybody in the system cries poor and believes that someone else is gouging us. But the system is so labyrinthine that nobody can figure out where the money is actually going. And every group (e.g., doctors) has an investment stake in the other groups (e.g., medical and malpractice insurance companies), or is a partner in an LLC that makes money by buying a machine and billing for its use.…

”The likely answer is: They are all gouging us.”

Exactly. It’s pointless to spend time on trying to find a single culprit. Corruption is spread throughout the whole system.

Re: Employer health plans are getting pricier and skimpier

#443

Post by beefalo » Thu, Sep 26, 2019, 5:12 AM UTC

deepaksurti wrote: post #438

greggman2 wrote: post #424

Earlier quoted context omitted.

In the USA, at least in my experience. If I have a cold I still had to make an appointment which would be 2 to 3 days later. I got around this by joining a doctor in a clinic and they'd let me see any doctor if my doctor wasn't avaiable but i'd have to sit in the waiting room for 1 - 2 hrs. In Japan I have had mixed experiences: Good: * It's relatively cheap. Apprently the government sets prices. The government offer…

>> In Japan I have had mixed experiences: Replace ‘Japan’ with ‘metro cities in India’ and its almost the same. I can’t still fathom why there would be no walk in facilities for ailments like cold. I still remember my shock when in US I realised from a colleague that for my cold I need to wait because I can’t walk in and need to take an appointment.

Walk in facilities do exist in the US, but wait times can be 2+ hours because the supply is so constrained.

Re: Employer health plans are getting pricier and skimpier

#444

Post by Aeolun » Thu, Sep 26, 2019, 5:13 AM UTC

greggman2 wrote: post #424

nine_k wrote: post #417

Earlier quoted context omitted.

Regarding Europe, which I happen to have friends all over: it's not exactly as rosy. European countries do have more doctors per capita, which is good. They don't have nearly as much resources in the system, though. Come to a doctor with a bad cough, get a prescription for Paracetamol. You got to have a pretty bad infection to get a prescription for an antibiotic. Endure a long discussion with a doctor to renew an an…

In the USA, at least in my experience. If I have a cold I still had to make an appointment which would be 2 to 3 days later. I got around this by joining a doctor in a clinic and they'd let me see any doctor if my doctor wasn't avaiable but i'd have to sit in the waiting room for 1 - 2 hrs. In Japan I have had mixed experiences: Good: * It's relatively cheap. Apprently the government sets prices. The government offer…

> Unclean. Have been to several facilities that seemed unclean to me.

The thing I like about it is that you can just leave the unclean facilities behind and find a new doctor, and it will cost you exactly the same as the old one.

Re: Employer health plans are getting pricier and skimpier

#445

Post by Aeolun » Thu, Sep 26, 2019, 5:17 AM UTC

nostrademons wrote: post #345

mullen wrote: post #218

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. 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. Don't want to pay what the government says it is going to pay? Good luck finding customers then, because the government is bargaining on behalf of all of the customers in the US. So my mom and her boyfriend are both under Medicare now, as was her late 2nd husband. My mom and I had both ge…

So your conclusion is that we shouldn’t fix the part that we can fix because people will still be assholes?

Re: Employer health plans are getting pricier and skimpier

#446

Post by greggman2 » Thu, Sep 26, 2019, 5:28 AM UTC

deepaksurti wrote: post #438

greggman2 wrote: post #424

Earlier quoted context omitted.

In the USA, at least in my experience. If I have a cold I still had to make an appointment which would be 2 to 3 days later. I got around this by joining a doctor in a clinic and they'd let me see any doctor if my doctor wasn't avaiable but i'd have to sit in the waiting room for 1 - 2 hrs. In Japan I have had mixed experiences: Good: * It's relatively cheap. Apprently the government sets prices. The government offer…

>> In Japan I have had mixed experiences: Replace ‘Japan’ with ‘metro cities in India’ and its almost the same. I can’t still fathom why there would be no walk in facilities for ailments like cold. I still remember my shock when in US I realised from a colleague that for my cold I need to wait because I can’t walk in and need to take an appointment.

I noticed recently in the USA places like Walgreens you can see a doctor for colds. That seems like a great idea to me. I guess that's similar in Thailand and maybe Malaysia.

Re: Employer health plans are getting pricier and skimpier

#447

Post by mschuetz » Thu, Sep 26, 2019, 5:40 AM UTC

nine_k wrote: post #417

doctorpangloss wrote: post #404

Earlier quoted context omitted.

This isn’t a very good analogy. In a just world, nobody would go hungry, nor would anyone die prematurely or suffer needlessly due to lack of care. We can obviously afford both, in this country, just like they can everywhere else in Europe or Canada. So this entire argument about insurance is a straw man. It’s not the doctors who set up this world. It’s people who want to pay less taxes, but blame doctors.

Regarding Europe, which I happen to have friends all over: it's not exactly as rosy. European countries do have more doctors per capita, which is good. They don't have nearly as much resources in the system, though. Come to a doctor with a bad cough, get a prescription for Paracetamol. You got to have a pretty bad infection to get a prescription for an antibiotic. Endure a long discussion with a doctor to renew an an…

I'll chime in with my experience in Austria:

* If I have a cold, I go to a doctor without appointment and if I'm unlucky, I have to wait for 2 hours. Usually it's 30-60 minutes.

* If I have a specific thing that requires a specialist, I may or may not have to get a referral from a general practitioner first. Most specialist don't really need it, but for an allergy test I needed to get one. This puts me at 2 x 60 minutes wait time.

* Costs are close to nothing. Drugs will cost a little, up to around 6€ for a pack of meds. I have to pay 2€ for a doctors visit due to the specific insurance provider I have, which is okay. I needed to pay 12€ for an x-ray because it wasn't an emergency.

* My austrian insurance provider payed more than half of a hospital trip I had to take during vacation in Taiwan. Total cost of the trip to the hospital without insurance was 130€, which included check by the doctor, pain medications and some medical equipment. I had travel insurance, but I didn't use it because I was left with a bill of just 60€.

* A few times I was angry because a doctor only took 5 minutes time, prescribed some pain meds and sent me on my way. Told me all I can do right now is wait until it gets better. Turns out, that was the case.

* If it's an emergency, you get treated immediately.

I wouldn't trade our system for anything. It's not perfect, but it's perfectly fine.

Re: Employer health plans are getting pricier and skimpier

#448

Post by camhenlin » Thu, Sep 26, 2019, 5:46 AM UTC

Definitely feeling this during my company's health insurance renewal this year. I used to think that I had it pretty alright, but over the past few years, things have gotten worse and worse. This year, for our "gold" plan, which was sold as the equivalent of the previous year's "gold" plan, our insurance provider increased our monthly cost by approx $120/mo, and increased our deductible by $5,000, up to $15,000.

I used to be against single payer, but now I'm rooting for any politician that thinks they can pull it off. I'm willing to pay a bit more tax in exchange for no longer having the "best" health insurance plan that I can afford that, quite frankly, I am terrified to use. Health care costs in this country are completely out of control. We need to have the system burned down and rebooted.

Re: Employer health plans are getting pricier and skimpier

#449

Post by xivzgrev » Thu, Sep 26, 2019, 5:49 AM UTC

throwaway66920 wrote: post #411

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…

This is a good analogy because it highlights the important problem. Insurance companies are incentivized to have healthcare prices increase so long as they get a discount. Why? Because it increase their value to the consumer to the point of necessity.

Also they are only allowed to make a certain profit margin: cost plus. One way to grow your profits is for the underlying cost to increase.

"The Affordable Care Act kept profit margins in check by requiring companies to use at least 80 percent of the premiums for medical care. That's good in theory, but it actually contributes to rising health care costs. If the insurance company has accurately built high costs into the premium, it can make more money. Here's how: Let's say administrative expenses eat up about 17 percent of each premium dollar and around 3 percent is profit. Making a 3 percent profit is better if the company spends more."

https://www.npr.org/sections/health-shots/2018/05/25/6136857...

Re: Employer health plans are getting pricier and skimpier

#450

Post by CuriouslyC » Thu, Sep 26, 2019, 5:49 AM UTC

throw_xyzyz wrote: post #271

eric_b wrote: post #248

Earlier quoted context omitted.

Sure, the government can say they'll only pay half as much as they do now, so providers will only provide half the care. Have you ever actually done any government procurement? Saying the government can just wave a magic wand and lower prices because "they said so" will only hurt the quality of care patients receive in the US.

The quality of care is already so low that you're better off financially and health wise just flying to Europe, or fleeing to Canada.

Thailand. Some of the best medical care of any developing nation, at around 10% of the price for most procedures. A night in a very clean, modern Thai hospital can be less than $100/night.