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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

#471

Post by watertom »

kmjg88nvf8 wrote: post #462
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…

Can you explain to a Non-American what forces this system of employer insurance onto the US? Why don't independent insurance companies emerge that offer other models of insurance?

Big business likes the level of control. Employees are limited in their job mobility, especially to small companies. It restricts competition, it also suppressed wages.

Big business in the U.S. gets what it wants, and if they didn’t want employer provided healthcare it would be gone, but it’s not gone so it means they like it.

If there was universal healthcare in the U.S. there would be an explosion of small business. Most small business can’t afford to provide healthcare, and if you have an existing health condition there is no guarantee that the plan from your new employer, if they have a plan, will include your doctor, or that they agree with the old doctor’s treatment plan.

Re: Employer health plans are getting pricier and skimpier

#472

Post by baq »

mosselman wrote: post #456
nextstep wrote: post #455

Earlier quoted context omitted.

This would be great if health choices were being made by rational consumers. But when I break my leg, I want services quickly and I don’t have time or energy to price compare ambulances. Healthcare is not a marketplace that will have compassionate outcomes if we allow deregulation.

Yes, because in countries where health care prices are 3-100x lower it is total anarchy. People lie on the streets for hours, browsing price comparison websites while bleeding out.

in most countries you don't get billed your quarterly wage when an ambulance picks you up for a 10 min drive to the hospital.

Re: Employer health plans are getting pricier and skimpier

#473

Post by orborde »

kmjg88nvf8 wrote: post #462
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…

Can you explain to a Non-American what forces this system of employer insurance onto the US? Why don't independent insurance companies emerge that offer other models of insurance?

One major factor in the US is that, from the perspective of an employee, employer plans have a massive tax advantage compared to anything the employee could buy outside their employer.

If your employer pays your insurance premiums, this doesn't count as taxable income for you. So you effectively have a choice that looks like:

- Your employer directly pays $200/mo for your insurance, or

- Your employer pays you $200/mo as cash, the government takes $40 (adjust as appropriate for tax bracket) out as income taxes, and you have $160/mo left over to pay for health insurance.

I can't really speak to the political forces that keep this subsidy in place, though.

https://www.taxpolicycenter.org/briefing-book/how-does-tax-e...

Re: Employer health plans are getting pricier and skimpier

#474

Post by jacobush »

rayiner wrote: post #334
philjohn wrote: post #309

Earlier quoted context omitted.

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 w…

The difference in drug spending between countries amounts to a small fraction of overall healthcare spending. $1200 a year in the US versus $900 in Switzerland or $800 in Germany, Canada, and Japan.

It's incidental what the numbers are. Given how effed the US system is, I would fully expect that $1200 being spent on the entirely wrong things, like a few super expensive drugs, and a lot of antibiotics which should have been dirt cheap getting a ridiculous markup, or on Oxycontin.

Re: Employer health plans are getting pricier and skimpier

#475

Post by BrainInAJar »

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…

> but that it would have to be much _more_ like grocery stores to call it a free market.

Except not really. If I'm poor I can choose to eat nothing but ramen. I might not like it, it might not be the best for me, but it'll keep me alive. If I'm poor and have a heart attack I can't choose to just take tylenol, I do need that bypass surgery.

The ability to walk away from a transaction entirely is what makes the market free, and because health care is life or death there is simply no way to make it a free market, you are compelled by your life to make (many? most?) of the transactions.

Re: Employer health plans are getting pricier and skimpier

#476

Post by jacobush »

maxerickson wrote: post #318
Andrex wrote: post #267

Earlier quoted context omitted.

I was going to comment the same thing. Pointing to Medicare/Medicaid as examples for why drug negotiation doesn't work is an impressively incorrect line of thought.

Medicaid mandates drug prices at a fixed percentage of what private buyers pay.

So just raise prices.

Re: Employer health plans are getting pricier and skimpier

#477

Post by kmjg88nvf8 »

watertom wrote: post #471
kmjg88nvf8 wrote: post #462

Earlier quoted context omitted.

Can you explain to a Non-American what forces this system of employer insurance onto the US? Why don't independent insurance companies emerge that offer other models of insurance?

Big business likes the level of control. Employees are limited in their job mobility, especially to small companies. It restricts competition, it also suppressed wages. Big business in the U.S. gets what it wants, and if they didn’t want employer provided healthcare it would be gone, but it’s not gone so it means they like it. If there was universal healthcare in the U.S. there would be an explosion of small business…

How can "big business" prevent alternative insurance companies?

Re: Employer health plans are getting pricier and skimpier

#478

Post by kmjg88nvf8 »

orborde wrote: post #473
kmjg88nvf8 wrote: post #462

Earlier quoted context omitted.

Can you explain to a Non-American what forces this system of employer insurance onto the US? Why don't independent insurance companies emerge that offer other models of insurance?

One major factor in the US is that, from the perspective of an employee, employer plans have a massive tax advantage compared to anything the employee could buy outside their employer. If your employer pays your insurance premiums, this doesn't count as taxable income for you. So you effectively have a choice that looks like: - Your employer directly pays $200/mo for your insurance, or - Your employer pays you $200/m…

So if you insure yourself privately, you can not deduct it from taxes? That would be an issue then, but seems easy to fix. Why isn't that part of the health care discussion?

Re: Employer health plans are getting pricier and skimpier

#479

Post by ddnb »

mschuetz wrote: post #447
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…

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 minu…

Exactly the same experience here in Belgium, only the doctor visit costs are way higher. Instead of €2 it's more like €25 per visit or I think €35 for home visits. I don't have experience with costs abroad so can't comment on that.

What is correct is that in Belgium you also don't get antibiotics because you ask for them. Only when the doctor deems it necessary you will get it.

Re: Employer health plans are getting pricier and skimpier

#480

Post by orborde »

kmjg88nvf8 wrote: post #478
orborde wrote: post #473

Earlier quoted context omitted.

One major factor in the US is that, from the perspective of an employee, employer plans have a massive tax advantage compared to anything the employee could buy outside their employer. If your employer pays your insurance premiums, this doesn't count as taxable income for you. So you effectively have a choice that looks like: - Your employer directly pays $200/mo for your insurance, or - Your employer pays you $200/m…

So if you insure yourself privately, you can not deduct it from taxes? That would be an issue then, but seems easy to fix. Why isn't that part of the health care discussion?

You can deduct it, but there are a couple of distinct minimums in the tax code for how much you have to spend before it starts reducing your taxable income. ( https://www.insurance.com/health-insurance/health-insurance-... )

Also, for simplicity, I left out payroll taxes, which are invisibly paid by your employer directly to the government ( https://squareup.com/us/en/townsquare/payroll-taxes-defined ).

So the choice from earlier is actually more correctly stated as:

- Your employer directly pays $220/mo for your insurance, or

- Your employer pays you $200/mo as cash and pays $20/mo directly to the government in payroll taxes, totaling $220/mo. Then the government takes $40 (adjust as appropriate for tax bracket) out of your paycheck as income taxes, and you have $160/mo left over to pay for health insurance.

The payroll tax issue would apply even if you could fully deduct the $200/mo from your personal taxable income.

> seems easy to fix. Why isn't that part of the health care discussion?

I am as mystified as you are.

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